Civil Remedy Notice of Insurer Violations
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Filing Number:     798139
Filing Accepted:  12/24/2024
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Complainant
Last/Business Name *  
BELCHER   First Name   JEFFREY
Street Address * 578 BOUNDARY BLVD.
City, State Zip * ROTONDA WEST, FL 33947
Email Address * JBELCHER2222@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BELCHER   First Name   JEFFREY AND TAMMY
Policy # * 30060748-02 Claim #* 22FLHOV0006663
Attorney
Attorney is Applicable
Last Name* MATTOCKS First Name * JACI Initial
Street Address* 888 SE 3 AVE, SUITE 300
City, State Zip* FT. LAUDERDALE , FL 33316
Email Address * JMATTOCKS@SCHIRMERLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   OLYMPUS INSURANCE COMPANY
NAIC Company Code 12954
 
Name of individual responsible for violation (if any):* - DONALD L. WILLIAMS, JR. AND STEPHANIE MORRIS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Other : Misrepresentation regarding policy provisions and coverage
Other : Failure to properly investigate claim and with due regard to insured
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

See subject Policy: Olympus Insurance Company Policy Number: 30060748-02 SECTION I – CONDITIONS C. Loss Settlement In this Condition C., the terms "cost to repair or replace" and "replacement cost" do not include the increased costs incurred to comply with the enforcement of any ordinance or law, except to the extent that coverage for these increased costs is provided in E.11. Ordinance Or Law under Section I-Property Coverages. Covered property losses are settled as follows: 1. Property of the following types: a. Personal property; b. Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings; c. Structures that are not buildings; and ... at actual cash value at the time of loss but not more than the amount required to repair or replace. 2. Buildings covered under Coverage A or B at replacement cost without deduction for depreciation, subject to the following: In form HO 00 03, C. Loss Settlement Paragraph C.1.d., is deleted. Paragraph C.2.a. is deleted and replaced by the following: a. If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, after application of any deductible and without deduction for depreciation, but not more than the least of the following amounts: (1) The limit of liability under this policy that applies to the building; (2) The replacement cost of that part of the building damaged with material of like kind and quality and for like use; or (3) The necessary amount actually spent to repair or replace the damaged building. If the building is rebuilt at a new premises, the cost described in (2) above is limited to the cost which would have been incurred if the building had been built at the original premises. (4) "Emergency Mitigation Services" will be adjusted in accordance with SECTION I-PROPERTY COVERAGES, Additional Coverages, 2. "Emergency Mitigation Services" of this policy. (5) All repairs other than "Emergency Mitigation Services" performed by repair person(s), contractors, or assignees shall not exceed the reasonable and necessary labor, materials, costs, or measures to repair the property, unless otherwise specifically covered under the terms and conditions of the policy (e.g. ordinance or law coverage). ... In form HO 00 03, C. Loss Settlement, the first paragraph of C.2.d is replaced by the following: We will initially pay the actual cash value of the loss, less any applicable deductible. We will then pay any remaining amounts necessary to perform the actual repair or replacement as work is performed and expenses are incurred subject to C.2.a. and b. If a total loss occurs, we will pay the full replacement cost without reservation or holdback of any depreciation in value. Section I – PROPERTY COVERAGES B. Coverage B – Other Structures 1. We cover other structures on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection.
 
* Facts and circumstances giving rise to the violation.
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This Civil Remedy Notice is given in order to perfect the right to pursue the civil remedy authorized by §624.155 and §626.9541, Florida Statutes. On or around September 28, 2022, while the Policy was in full force and effect, the insureds, Tammy and Jeffrey Belcher (hereinafter, the “Insureds”), suffered water damages to their insured property located at 578 Boundary Blvd., Rotonda West, FL 33947 (hereinafter “the Property”). The Insureds timely submitted their claim for benefits to Olympus Insurance Company (hereinafter “Olympus”) on October 2, 2022, and Olympus subsequently assigned claim number 22FLHOV0006663 and sent a field adjuster, James Buro, to inspect the Property on October 7, 2022. Pursuant to the subject Policy and Mr. Buro’s inspection, Olympus opened coverage and issued payment to the Insureds on or around January 2, 2023, for $28,236.65 for Coverage A and $1,424.55 for Coverage B after the $8,559.00 policy deductible (hereinafter “First Coverage Letter”). The First Coverage Letter attached the estimate completed by Mr. Buro. According to Mr. Buro’s estimate he allocated $2,939.73 for the removal and replacement of the picket fence in the Property’s backyard, then subtracted $1,515.18 as recoverable depreciation totaling the $1,424.55 Coverage B payment that was mentioned above. Pursuant to SECTION I – CONDITIONS, C. Loss Settlement Section of the Special Provisions of the Policy, states that “covered property losses are settled as follows: 1. Property of the following types: a. Personal property, b. Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings, c. Structures that are not buildings, and ... at actual cash value at the time of loss but not more than the amount required to repair or replace.” Therefore, Olympus made a material misrepresentation, in violation of F.S. §626.9541(1)(i)(2), 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. This was also a misrepresentation of the aforementioned provisions relating to coverage at issue, specifically to the loss settlement amount paid by Olympus, in violation of F.S. §626.9541(1)(i)(3)(b), because Olympus improperly withheld depreciation for the picket fence, when the Policy clearly states that structures that are not buildings, i.e. the picket fence, should be paid “at the actual cash value at the time of the loss.” This was also a violation of F.S. §626.9541(1)(i)(3)(a) as this was a clear failure of Olympus to adopt and implement standards for the proper investigation of this claim. The adjuster just looked at the estimate prepared on Olympus’ behalf and completely disregarded the applicable Policy and verbiage included in same and instead, issued an underpayment to the Insureds for Coverage B. The First Coverage Letter further stated, “[I]n addition, we ask that you present us with a detailed estimate of the damages you are claiming which should outline any dispute as to scope and/or price”. The Insureds did just that, the Insureds contested the scope of coverage, as the payment proffered by Olympus was inadequate to address all of the damages to the Property. As a result, the Insureds provided a detailed estimate for the damages resulting from the subject loss. Shortly thereafter a roofing contract was submitted to Olympus by the Insureds’ representatives. Olympus confirmed receipt of both of these documents via its Corporate Representative’s subsequent deposition testimony provided in this case. It is important to note that the estimate that was attached to the First Coverage Letter provides the total estimated actual cash value (hereinafter “ACV”) cost of the roof was $27,272.52 (this was after the estimate was revised by someone other than Mr. Buro – per his deposition testimony under oath) less $15,149.77 for recoverable depreciation, totaling a payment amount of $12,122.75 for the roof replacement’s recoverable cash value (hereinafter “RCV”). Thereafter, on February 28, 2023, the Insureds provided access yet again, for a third pre-suit inspection of the Property by an engineer on behalf of Olympus. In violation of F.S. §626.9541(1)(i)(3)(g), Olympus failed to promptly notify the Insureds of any additional information it needed to process their claim. Over a month went by following the third inspection and finally on March 30, 2023, over a month after the February 28, 2023, engineer inspection, Olympus issued a supplemental payment to the Insureds under the Policy, in the amount of $36,455.42, specifically $29,044.43 for Coverage A, $7,082,96 for Coverage C, and $328.03 for Coverage D (hereinafter “Second Coverage Letter”). This Coverage A payment was for the RCV for the roof ($15,149.77), and emergency mitigation services ($1,850.00 for mold test and $12,044.66 for mold remediation). The Second Coverage Letter fails to advise the Insureds that a portion of the Coverage A payment was for the roof’s RCV and the list of enclosures in which the payment was allegedly based on did not include a copy of the roof contract previously submitted by the Insureds. Therefore, Olympus issued a total amount of $27,272.52 for the replacement of the Property’s roof. However, the cost to replace the roof was actually $32,458.11, as reflected by the roof contract submitted to Olympus and relied upon by Olympus to issue the recoverable depreciation with the Second Coverage Letter. The Policy specifically provides in the Special Provisions as follows: HO 00 03, C. Loss Settlement, the first paragraph of C.2.d is replaced by the following: We will initially pay the actual cash value of the loss, less any applicable deductible. We will then pay any remaining amounts necessary to perform the actual repair or replacement as work is performed and expenses are incurred subject to C.2.a. and b.” In violation of F.S. §626.9541(1)(i)(2) Olympus made a material misrepresentation to the Insureds regarding the amount owed to them as it relates to the covered roof replacement, 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. In violation of F.S. §624.155(1)(b)(1), Olympus’s failure to attempt in good faith to settle at a minimum the roof portion of the claim 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 their interests. This is also a violation of §626.9541(1)(i)(3)(a) as this was yet another clear failure of Olympus to adopt and implement standards for the proper investigation of this claim. The adjuster just looked at the estimate prepared on Olympus’s behalf and completely disregarded the roof contract and applicable Policy and verbiage included in same and instead, issued an underpayment to the Insureds for their covered roof. Based on receipt of the estimate and other documents provided by the Insureds and or their representatives it is clear that Olympus has underpaid the Insured’s claim by over $20,000 for Coverage A alone (this is excluding the estimated cost to replace the damaged windows and doors that are in dispute by Olympus). Yet Olympus still has not attempted to settle the claim in good faith 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 Insureds’ interests, in violation of F.S. §624.155(1)(b)(1). Therefore, to cure the defects outlined in this Civil Remedy Notice, Olympus must: Immediately tender all insurance benefits due and owing to the insureds under the Policy pursuant to the relevant policy provisions provided herein, more specifically $1,515.18, for a portion of the damages they suffered under Coverage A that were improperly withheld as recoverable depreciation. Olympus must also tender $5,185.59, for the difference between the RCV as estimated by Olympus and what the Insureds actually spent on the roof replacement. In addition, Olympus must implement procedures to ensure that its adjusters are actively monitoring and applying the applicable payment provisions to all covered losses by the Insureds. Furthermore, the Insureds require an admission that they are entitled to reasonable attorneys’ fees and costs, to be determined by a judge pursuant to Fla. Stat. §627.428.
Comments
User Id Date Added Comment
coleen@zinoberdiana.com 02-12-2025 February 12, 2025 VIA ELECTRONIC FILING Florida Department of Financial Services Bureau of Consumer Services – Civil Remedy Larson Building, 200 East Gaines Street Tallahassee, FL 32399-0322 RESPONSE TO CIVIL REMEDY NOTICE OF INSURER VIOLATION Re: Insureds: Jeffrey and Tammy Belcher DFS Filing No.: 798139 Filing Accepted: December 24, 2024 Claim No.: 22FLHOV0006663 Policy No.: OIC30060748-02 Date of Loss: September 28, 2022 Dear Sir or Madam: The undersigned has the privilege of representing Olympus Insurance Company (“Olympus”) in the above-referenced matter. This correspondence constitutes Olympus’ formal response to the Civil Remedy Notice of Insurer Violation Number 798139 (“the Subject CRN”) filed by Jaci Mattocks, Esq. on behalf of Jeffrey Belcher. The Subject CRN was accepted by the Department on December 24, 2024. This response is timely under Florida Statutes. While Olympus welcomes the opportunity to respond to the Subject CRN, it must first note that the Subject CRN is not valid as it fails to comply with the specific requirements of Florida Statute §624.155. See Neal v. Geico Gen. Ins. Co., 358 So. 3d 749, 750 (Fla. 4th DCA 2023). Olympus further specifically denies each and every allegation contained therein as said allegations relate to this claim. Further, the Subject CRN fails to comply with the specific information requirements as set forth in Florida Statute §624.155 and Florida case law. Therefore, the Subject CRN is facially invalid, and it should be rejected and returned by the Department. The subject claim is regarding hurricane damage occurring September 28, 2022. Olympus investigated the subject loss and tendered payment for all covered damages resulting from the subject claim. As clearly noted in the plain language of the Subject Policy, and contrary to the claims in the Subject CRN, Olympus properly withheld Recoverable Depreciation from payments and tendered Actual Cash Value to the Insureds. Olympus also made subsequent payments resulting in Replacement Cost Value. The Subject CRN cites a number of specific statutes Olympus has allegedly violated. While Olympus categorically and unequivocally denies violating any statutes, Olympus will briefly address the specific statutes alleged to have been violated, in an abundance of caution. §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 Insureds and with due regard for her or his interests; Olympus denies this allegation, and the Subject CRN sets forth minimal actual facts to support this allegation, only opinions as to how the claim should have been resolved. The Subject CRN also sets forth several inaccuracies and incomplete information, such as such as alleging that Olympus failed to comply with the policy when it tendered Actual Cash Value, which is what the express terms and conditions of the policy state, and misstating the actual amount of the roof replacement, which was not discovered by Olympus until over a year into litigation. While Olympus has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insureds and with due regard for the interests of the Insureds, Olympus is also not obligated to pay more than what the terms and conditions of the subject policy require and, in the method, or manner required by same. The remainder of the Subject CRN simply states disparaging and unsubstantiated opinions regarding Olympus and its agents assisting in the investigation of the subject claim. Olympus acted in accordance with Florida Statute §624.155(1)(b)(1) and has in no way violated said statutory provisions. 626.9541(1)(i)(2) A material misrepresentation made to an Insureds 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. Olympus denies this allegation, and the Subject CRN sets forth no actual facts to support this allegation, only opinions as to how the claim should have been resolved. The “material misrepresentations” alleged in Subject CRN were not misrepresentations by Olympus but rather Olympus adhering to the terms and conditions of the subject policy. Olympus is not obligated to pay more than the terms and conditions of the subject policy require and, in the method, or manner required by same. Moreover, the Subject CRN itself contains misrepresentations, such as alleging Olympus improperly withheld Recoverable Depreciation and misstating the actual amount of the roof replacement cost. Olympus has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insureds and with due regard for the interests of the Insureds. Olympus acted in accordance with Florida Statute §626.9541(1)(i)(2) and has in no way violated said statutory provisions. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. Olympus denies this allegation, and the Subject CRN sets forth no actual facts to support this allegation, only opinions as to how the claim should have been resolved. The Subject CRN also sets forth several inaccuracies and incomplete information, such as such as alleging that Olympus failed to comply with the policy when it tendered Actual Cash Value which is what the express terms and conditions of the policy state, and misstating the actual amount of the roof replacement, which was not discovered by Olympus until over a year into litigation. While Olympus has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insureds and with due regard for the interests of the Insureds, Olympus is also not obligated to pay more than what the terms and conditions of the subject policy require and, in the method, or manner required by same. The remainder of the Subject CRN simply states disparaging and unsubstantiated opinions regarding Olympus and its agents assisting in the investigation of the subject claim. Olympus acted in accordance with Florida Statute §626.9541(1)(i)(3)(a) and has in no way violated said statutory provisions. 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Olympus denies this allegation, and the Subject CRN sets forth no actual facts to support this allegation, only opinions as to how the claim should have been resolved. The “misrepresentations” alleged in the Subject CRN were not misrepresentations by Olympus but rather Olympus adhering to the terms and conditions of the subject policy. Olympus is also not obligated to pay more than what the terms and conditions of the subject policy require and, in the method, or manner required by same. Moreover, the Subject CRN itself contains misrepresentations, such as alleging Olympus improperly withheld Recoverable Depreciation and misstating the actual amount of the roof replacement cost. Olympus has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insureds and with due regard for the interests of the Insureds. Olympus acted in accordance with Florida Statute §626.9541(1)(i)(3)(b) and has in no way violated said statutory provisions. 626.9541(1)(i)(3)(g) Failing to promptly notify the Insureds of any additional information necessary for the processing of a claim Olympus denies this allegation, and the Subject CRN sets forth no actual facts to support this allegation. Olympus communicated with the Insureds and their representatives throughout the claims process and has and continues to act fairly and honestly towards the Insureds and with due regard for the interests of the Insureds. Olympus acted in accordance with Florida Statute §626.9541(1)(i)(3)(g) and has in no way violated said statutory provisions. Invalidity of the Subject CRN As a condition precedent to bringing a bad-faith action against an insurer, Florida's Department of Financial Services and the insurer must be given 60 days' written notice of the claim, with such notice being in the form of a Civil Remedy Notice. See Landers v. State Farm Fla. Ins. Co., 234 So. 3d 856 (Fla. 5th DCA 2018). The purpose of a Civil Remedy Notice is to facilitate and encourage good-faith efforts to timely settle claims before litigation and to give a carrier one last chance to settle a claim with its Insureds and avoid unnecessary bad faith litigation. See Neal v. Geico Gen. Ins. Co., supra; Lane v. Westfield Ins. Co., 862 So. 2d 774, 775 (Fla. 5th DCA 2003). The plain language of Florida Statute §624.155(3)(b) instructs the policyholder to "state with specificity" information in the notice; to specify "language of the statute, which the authorized insurer allegedly violated;" and to "[r]eference . . . specific policy language that is relevant to the violation, if any." Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 878 (Fla. 4th DCA 2021). Also see Landers v. State Farm Fla. Ins. Co., 234 So. 3d 856 (Fla. 5th DCA 2018) (Civil Remedy Notice must set forth the specific statutory provision the insurer allegedly violated, the facts giving rise to the violation, the relevant policy language, and a statement that the notice is given to perfect the right to pursue the civil remedy authorized by the statute). The Subject CRN fails to meet the requirements of Florida Statute § 624.155 and interpreting case law and the defects in the Subject CRN are more than mere technical defects. See Julien v. United Prop. & Cas. Ins. Co., supra. As initial matters, the Subject CRN fails to comply with all statutory requirements as it names only Insured Jeffrey Belcher as the complainant; however, the subject policy was issued to Insureds Jeffrey Belcher and Tammy Belcher. The Subject CRN also fails to comply with all statutory requirements as it fails to list Olympus’ address. See Julien v. United Prop. & Cas. Ins. Co., supra; Pin-Pon Corp., supra. The Subject CRN further lists a total of five (5) statutes Olympus allegedly violated, yet the Subject CRN fails to provide specifics as to how, if at all, Olympus allegedly violated each statute. Moreover, as set forth herein, the Subject CRN sets forth no actual facts to support the allegations, only opinions as to how the claim should have been resolved. The Subject CRN also fails to comply with all statutory requirements as it sets forth several inaccuracies and incomplete information. The failure to provide any specific supporting facts for the allegations as required under Florida Statute §624.155 renders the Subject CRN invalid. In addition to the above deficiencies and failure to comply with all statutory requirements, the Subject CRN is not “specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days.” Valenti v. Unum Life Ins. Co. of Am., 8:04CV1615T-30TGW, 2006 WL 1627276, at *2 (M.D. Fla. 2006). The Florida Supreme Court has held that, to “cure” a Civil Remedy Notice, a carrier must pay the amount owed pursuant to the express terms and conditions of the policy.” Talat Enter., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, the Subject CRN demands payment of money that is not owed pursuant to the Subject Policy, such as attorney’s fees, costs, and interest. It is improper to demand such items as a cure for a Civil Remedy Notice. Id. The purpose of the Civil Remedy Notice is to give a carrier one last chance to settle a claim with its Insureds and avoid unnecessary bad faith litigation--not to give the Insureds a right of action to proceed against the carrier even after the Insureds’ claim has been paid. See Landers v. State Farm Fla. Ins. Co., 234 So. 3d 856, 858 n.6 (Fla. 5th DCA 2018) citing Lane v. Westfield Ins. Co., supra. See also Neal v. Geico Gen. Ins. Co., supra. (Purpose of the Civil Remedy Notice is to facilitate and encourage good-faith efforts to timely settle claims before litigation, not to vindicate continuing efforts to delay). Olympus asserts that this response is not necessarily exhaustive and does not preclude Olympus from asserting any other valid reason for seeking rejection and return of the Subject CRN. Also, this letter or any act or failure to act on the part of Olympus or any agent or representative of Olympus 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. Respectfully, ZINOBER, DIANA & MONTEVERDE, P.A. Michael A. Monteverde, Esq. Coleen M. Balkie, Esq. Michael@zinoberdiana.com Coleen@zinoberdiana.com CC: Jaci Mattocks, Esq. Schirmer Law, PLLC 888 SE 3rd Avenue, Suite 200, Fort Lauderdale, FL 33316 JMattocks@schirmerlaw.com; TPomaranski@schirmerlaw.com; Sassam@schirmerlaw.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