Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 797764

Filing Accepted: 12/20/2024

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Complainant

Last/Business Name *

MACKOWIAK

First Name

RICHARD & SUSAN

Street Address *

934 BENTWOOD LN

City, State Zip *

PORT ORANGE, FL 32127-48

Email Address *

YIA24@YOURINSURANCEATTORNEY.COM

Complainant Type: *

Insured

Last/Business Name*		MACKOWIAK		First Name		RICHARD & SUSAN
Policy # *		79CJY3670		Claim #*		59-75H0-42X

Attorney

Attorney is Applicable

Last Name*	DIAMOND First Name * PETER Initial
Street Address*		2601 S BAYSHORE DRIVE 5TH FLOOR
City, State Zip*		COCONUT GROVE , FLORIDA 33133
Email Address *		PD@YOURINSURANCEATTORNEY.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		STATE FARM FLORIDA INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10739

Name of individual responsible for violation (if any):* JAYCE LEWIS
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Failure to timely adjust the claim and pay the claim within the prescribed statutory claim period

* 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)(d)		Denying claims without conducting reasonable investigations based upon available information.
	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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The entire policy is incorporated herein as a basis for the specific policy language for which is relevant to the violation.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Shortly after Hurricane Milton, the Insured filed an insurance claim against the insurer for various damages. The claim was reported on October 13, 2024. The carrier acknowledged the claim , but the insurer failed to make a claims determination within the prescribed statutory deadline. The carrier had sixty (60) days to make a coverage determination, and they did not do so. The insured completed the necessary repairs and demanded the carrier to pay the withheld claim recovery of $58,443.49, including depreciation. The insured provided a proof of their damages and repairs (“SPOL”). The carrier is wrongfully withholding a total of $58,443.49. The carrier is not attempting and has not attempted, 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 the insured’s interests. As stated above, the carrier has been in receipt of the insured’s SPOL since November 27, 2024. Since that time, the carrier has not made a coverage determination or issued payment and instead has dragged its feet in adjusting the claim and more importantly resolving the claim. The insured has attempted in good faith to resolve this matter. The carrier has completely failed to promptly settle the insured’s claim, despite a clear obligation to settle a claim should have become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. The Carrier failed to acknowledge and act promptly upon communications with respect to claims. The insured has been left in the dark regarding the end date for claim resolution and all along the carrier has not fully indemnified the insured who has suffered tremendous losses. The insurer should have recognized immediately that the insurer low balled the insured on claim value and should immediately tender payment for the full value of the claim. To cure this blatant bad faith claim handling, the insurer can immediately tender the following amount $58,443.49 for indemnity. Additionally, the insured seeks compensation for attorney's fees and costs of $11,688.70 plus interest, as well as $25,000.00 for the bad faith delay and claims handling failures. Total Damages to resolve this entire CRN, conditioned on a release, is $95,132.19.

Comments

User Id		Date Added		Comment
peter@peterdiamondlaw.com		01-21-2026		The parties have amicably resolved this matter and the instant CRN is whereby withdrawn.
mcorbin@hamiltonmillerlaw.com		02-18-2025		Dear Mr. and Ms. Mackowiak: The undersigned represents State Farm Florida Insurance Company (“State Farm”) with respect to the Civil Remedy Notice referenced above. This correspondence constitutes State Farm’s formal response to the Civil Remedy Notice of Insurer Violation (“CRN” or “the Notice”) filed on behalf of you, Richard and Susan Mackowiak (“the Insured” or “the Complainants”), by your attorney. State Farm believes that the CRN is facially invalid and that it should be rejected by the Department of Financial Services as it completely fails to comply with the specific requirements as set forth in Florida Statute § 624.155 and as described in Florida case law. Florida Statute § 624.155 requires that a Complainant state with specificity the statutory provision(s) alleged to have been violated, the facts and circumstances giving rise to each violation, the name of any individual involved in the violation(s), and specific policy language relevant to the alleged violation(s). In Talat Enterprises. Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1278, 1284 (Fla. 2000), the Florida Supreme Court explained that “[i]n creating this statutory remedy for bad-faith actions, the Legislature provided this sixty-day window as a last opportunity for insurers to comply with their claim-handling obligations when a good-faith decision by the insurer would indicate that contractual benefits are owed.” The plain language of the statute clearly requires that an insured specify the statutory provision, policy language, and facts and circumstances surrounding the alleged violation. See, e.g., Nowak v. Lexington Ins. Co., 464 F. Supp. 2d 1248, 1251 (S.D. Fla. 2006); Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 878 (Fla. 4th DCA 2021) (dismissing the lawsuit for failure to meet section 624.155’s specificity requirements for both statutes and policy language); Fonollosa v Am. Integrity Ins. Co. of FL, 2021 Fla. Cir. Lexis 5 (11th Cir Ct., Miami-Dade Cty 2021) (holding the CRNs do not satisfy the requirements of section 624.155(3)(b) because they do not state with specificity the facts and circumstances giving rise the alleged violations, names of individuals involved, statutory provisions and specific language of the statutes allegedly violated, or the specific policy language relevant to the alleged violations). As to the section to reference specific policy language, your CRN fails as you merely say the “entire policy is incorporated herein as a basis for the specific policy language for which is relevant to the violation.” According to case law, listing the entire policy fails the specificity requirement. Florida Courts have ruled that the “‘kitchen sink’ approach does not satisfy the specificity requirements of section 624.155.” Demase v. State Farm Fla. Ins. Co., 351 So. 3d 136, 141 (Fla. 5th DCA 2022) (citing Julien, 311 So. 3d at 879-880) (affirming trial court's determination that plaintiff “failed to satisfy the requirement that the insured identify the specific statute and specific policy provision relevant to [the insurer]’s alleged violation” when complainant listed 35 statutes and nearly the entire policy). Here, the CRN contains the same fatal flaw by explicitly stating the entire policy is related to the violation. For this additional reason, this section and, therefore, the CRN fails. The CRN alleges seven different statutory violations. According to pertinent case law, merely listing a multitude of statutes fails to meet the required specificity. Exacerbating this failure is that there are no facts and circumstances giving rise to the statutory violations to support these alleged violations. The narrative section of the Notice contains nothing but vague, conclusory, and inaccurate statements that bear no relation to the subject-matter claim. First, the CRN begins by alleging that the insurance carrier has 60 days to make a claim determination , but did not do so. This statement is misleading. While the relevant statute states that an insurer has 60 days after receiving a property insurance claim it shall pay or deny such claim or a portion of the claim, it goes on to say, “unless the failure to pay is caused by factors beyond the control of the insurer.” In this case, State Farm repeatedly attempted to get information from the Insureds and their representatives over the course of the investigation, but they and their representatives failed to respond or delayed responses such that State Farm was unable to make a complete investigation and determination before this CRN was filed. Thus, there were factors beyond the control of State Farm. For example, State Farm received this claim on October 12, 2024. The claim was acknowledged and within 2 days a State Farm representative attempted to contact both the Insureds on their phone numbers provided to it. However, no one answered. Voicemails were left for them, but State Farm did not receive any call-back. Letters requesting contact were sent on October 14 and 29, 2024. Additional attempts were made over the course of weeks, but the same results. About 3 weeks after the claim was initially reported, State Farm received a letter of representation from the Insureds’ attorney. Upon receiving same, State Farm acknowledged the letter and contacted the attorney to schedule an inspection, which was set for November 14, 2024 – 35 days after the date of loss reported to State Farm. Inspection of the exterior occurred as scheduled, however, inspection of the entire interior was not allowed as, unfortunately, one of the Insureds was ill. Insured Susan Mackowiak did state that there was no ceiling damage anywhere inside the home. Also upon inspection, State Farm determined additional information was necessary to complete the evaluation of the claim, including photos and invoices for tree removal, and sent correspondence on November 14, 2024 listing additional items needed. No response was received. The CRN continues to misrepresent the facts. It says that the Insured provided a Sworn Statement in Proof of Loss (SPOL) on November 27, 2024. However, that is not true. The Insureds’ attorney did not send the SPOL, nor any other information, until December 20, 2024 – the same date this CRN was filed. In fact, the SPOL was not even executed by the Insureds until December 20, 2024. The Proof of Loss was untimely pursuant to the terms of the policy. Additionally, it did not provide the information previously requested. State Farm promptly responded. On January 17, 2025, the attorney filed a Notice of Intent to Initial Litigation, including the same estimate previously provided, but not the information requested. State Farm responded by requesting a re-inspection. After multiple attempts to schedule same, it occurred on February 11, 2025. State Farm determined damages to the dwelling shingle roof and garage ceiling and prepared an estimate for $22,703.69 Replacement Cost Value (RCV) for full replacement of the roof, re-screening of enclosure, repair/replacement of fascia and soffit, and painting of soffit, and drywall repair and painting the garage. The estimate noted State Farm was still pending additional information for the tree removal. Subtracting the deductible of $2,797 and withheld recoverable depreciation (RD) of $4,234.02, State Farm made a net payment of $15,672.67 on February 12, 2025 to the Insureds via their attorney. Correspondences were sent explaining the payment and how to collect the RD or any other additional amounts that may be incurred and evaluated. State Farm also found that the wind damage to the metal roof panels is the same damage as prior loss claim number 59-40F2-38R for Hurricane Ian two years prior to the subject-matter loss. Inspection of certain portions of the property was again declined due to illness. Other damages observed, but not claimed in the Insureds’ estimate, were denied due to policy exclusions. The CRN continues with general and boilerplate accusations before it makes an invalid cure – to tender the amount of a contractors’ inflated estimate, pay attorney’s fees and costs of $11,688.70 plus interest, and $25,000 for the “bad faith delay and claims handling failures.” They demand $95,132.19, conditioned on a release. The demands for payment of an inflated estimate that was not provided to the insurer until the day the CRN was filed and prior to completion of an investigation is improper Further, the demand for attorney’s fees and costs with interest and an amount for “bad faith” in the CRN itself are invalid. Furthermore, despite the legal insufficiency of this CRN, State Farm states that it paid undisputed damages prior to the 60-day cure period and explained it is still pending information on tree remove, how to collect withheld recoverable depreciation once repairs are made (or a valid, executed contract is provided), and how to make a supplemental claim. The foregoing true facts of the claim allow me to address each of the alleged statutory violations individually. 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. State Farm denies this allegation. It gathered information about the weather on the date of loss, inspected the property, and requested additional information from the Insureds and their representative, which was not forthcoming. Upon re-inspection, State Farm paid undisputed damages prior to expiration of this CRN. Coverage and estimate were explained in writing. 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. This allegation is nonsensical and, therefore, denied. There was partial coverage under the policy, which has been paid. There was no payment under one coverage to influence another. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. The Insured presents no facts to support this assertion and, therefore, it is denied. State Farm acknowledged the claim, sought information from the Insured through them and their representatives, sought information from other sources, inspected the property for damages, cause of loss and date of loss, and informed additional information was needed to complete the investigation, which was never provided. Nevertheless, State Farm requested re-inspected and conducted additional investigation to determine partial coverage and made payment. State Farm has standards for the proper investigation of claims and followed them. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. There are no facts asserted to show that State Farm failed to promptly acknowledge or act on communications. The CRN contains incomplete and false allegations. State Farm made efforts to communicate with the Insureds and their representative, but received no or delayed responses. They were sent contact letters and request for information. State Farm responded to the untimely SPOL and requested reinspection. Upon same, a claim determination as to the portions of the property they permitted inspection and submitted information and undisputed amounts were paid. Thus, this allegation is denied. 626.9541(1)(i)(3)(e) Denying claims without conducting reasonable investigations based upon available information. At the time this CRN was filed, a claim determination had not yet been made. Thus, this allegation is nonsensical and denied. 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. This statutory language has nothing to do with the claim at hand. This CRN was filed the SAME DAY the proof of loss was executed by the Insured and provided to State Farm. Therefore, this allegation is denied. 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. This allegation is denied as State Farm sent correspondence to the Insureds requesting additional information, but did not receive it. Upon obtaining the information need through reinspection and additional investigation, the insureds were notified in writing of the basis in the policy and facts via letter and estimate with payment of the undisputed amount. By filing the CRN prematurely, alleging the entire policy is at issue, and listing seven different statutes with misleading facts as the basis for same, State Farm was prevented from engaging in any meaningful review of the policy terms, conditions, and actions of State Farm with which the Complainants take issue. In addition, State Farm asserts that the CRN is cured as the Insureds have been notified in writing of the claim determination and undisputed amounts paid, with explanation on how to make a claim for supplemental damages and/or withheld recoverable depreciation. The CRN should be invalidated due to its failure to comply with Florida Statute § 624.155 and Florida case law in every respect. Nevertheless, State Farm asserts it violated no Statutes nor the policy provisions and avers that it acted at all times in good faith. Please note that this response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for seeking rejection of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of State Farm or any agent or representative of State Farm should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Sincerely yours, Mary E. Corbin

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. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

DFS-10-363
Rev. 10/14/2008