Civil Remedy Notice of Insurer Violations
Login

Filing Number:     798545
Filing Accepted:  12/29/2024
         Print Filing
Complainant
Last/Business Name *  
BOYD   First Name   DANIEL
Street Address * 1632 GROVE AVE.,
City, State Zip * FORT MYERS, FL, FL 33901
Email Address * BOYD1300@MAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BOYD   First Name   DANIEL
Policy # * FPH5350176-01 Claim #* FPI235090
Attorney
Attorney is Applicable
Last Name* FINCH First Name * ALEX Initial
Street Address* 516 WHISPER WOOD DRIVE
City, State Zip* LONGWOOD , FL 32779-2541
Email Address * AFINCHLEGAL@GMAIL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FLORIDA PENINSULA INSURANCE COMPANY
NAIC Company Code 10132
 
Name of individual responsible for violation (if any):* ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEY’S AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY THE INSURANCE COMPANY INVOLVED WITH THE HANDLING AND/OR ADJUSTMENT OF THE CLAIM.
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)(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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
627.7283(1) If the insured cancels a policy of motor vehicle insurance, the insurer must mail the unearned portion of any premium paid within 30 days after the effective date of the policy cancellation or receipt of notice or request for cancellation, whichever is later. This requirement applies to a cancellation initiated by an insured for any reason.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

DANIEL BOYD (THE “COMPLAINANT”) IS THE INSURED UNDER THE SUBJECT REDSIDENTAIL PROPERTY INSURANCE POLICY. COMPLAINANT ASSERTS THAT, INCLUDING BUT NOT NECESSARILY LIMITED TO, THE FOLLOWING POLICY PROVISIONS ARE SPECIFICALLY RELEVANT AND APPLICABLE: The Declaration Page for the effective policy period. The “Agreement” provision provides that the insurer described in the policy in exchange for paid premiums and insured’s compliance with the policy provisions; “Definitions” -”Insured” defines who the insured is under the policy; “Insured location” defines “residence premises” as the real property insured under the policy; “Occurrence” is defined as an accident which results in “property damage”; “Property damage” is defined as physical injury to tangible property; “Residence premises” is defined as the dwelling on the insured property as described on the Declaration Page; “Coverage A – Dwelling” establishes that the policy provides insurance for the dwelling shown in the Declarations together with materials and supplies located on or next to the dwelling; “Coverage B – Other structures” provides coverage for other structures on the insured premises set apart from the residence premises/dwelling by clear space; “Coverage C – Personal Property” provides coverage for personal property of the insured usual to the occupancy of the dwelling. “Coverage D – Loss of Use” provides coverage for loss of normal use of the property as a result of a covered peril. “Additional Coverages” –“ Debris Removal” provides coverage to remove debris created by damage from a covered event; “Reasonable Repairs”; “Property Removed” provides coverage for removal of debris resulting from damages resulting from a covered peril; “Loss Assessment” provides coverage for reimbursement of the insured’s expenses for any assessment against the insured by a corporation or homeowner’s association for damages incurred by a covered peril. The Landlord Furnishings provision provides coverage for damages to the insured’s identified property occasioned by windstorm or hail.; “Landlord’s Furnishings – Windstorm or hail” provides coverage for damages to the insured’s identified property occasioned by windstorm or hail. “Perils Insured Against” provides coverage for losses under Coverage A, Coverage Band Coverage C. The “Duties After Loss” provision provides for obligations of the insured to comply with the terms of the policy after providing notice of a loss including cooperation with the insurer for investigation of the claimed loss. The “Loss Settlement” provision provides the method utilized to settle and pay claims under the policy. The “Appraisal” provision provides a mediation and appraisal process by which either the insurer or the insured may use to resolve disputed claims of loss. The “Suit Against Us” provision provides conditions governing the insured’s ability to conduct litigation against the insurer. The “Loss Payment” provision provides the method utilized to settle and pay claims under the policy. All endorsements to the policy effective as of the asserted date 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.

This notice is given in order to perfect the right to pursue the civil remedy authorized by F.S. §624.155. Complainant is an insured property owner. Florida Peninsula Insurance Company. (hereinafter “Insurer”), refused and failed to pay Complainant all benefits due and owing for necessary services to be rendered after a loss from Hurricane Ian. On or around September 28, 2022, Insured suffered severe and substantial damages to real property caused by a covered peril. The Complainant retained a license contractor who then inspected the property and determined that there were substantial damages the replacement cost value in the amount of $43,909.91, which included a full roof replacement and other damages. These damages are vastly greater than the estimate prepared by Insurer. Insurer sent a representative to the Insured’s property who conducted a hurried, hasty, and inadequate inspection. Insurer, in conformance with Insurer’s guidelines, prepared an estimate that drastically undervalued the Insured’s claim. In fact, Insurer determined that the damages were only $12,300.00, leaving a disputed coverage amount of $31,609.91. After receiving a proper estimate along with the documentation necessary to substantiate the contractor's estimate, findings and causation of the damages from a covered peril under the policy, Insurer failed to make an appropriate estimate of value or to pay the insurance proceeds due under the policy, even though the damages were clearly greater than the Insurer’s estimate. There are at least three reasons why a simple repair of the roofing system is not an option. First, § 626.9744(2), Fla. Stat. states: “When a loss requires replacement of items and the replaced items do not match in quality, color, or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas…” In this case, the shingles that are on the roof were damaged and discontinued. Additionally, the shingles faded over time and cannot be matched. Florida’s matching statute requires matching of the shingles. Second, the underlayment of the roofing systems is so compromised that it cannot repairs and must be replaced in its entitely. As such, a repair of the roofing system is not an option since the law requires that all tiles be brought up to code. Third, § 708.1.1 of the Florida Building Code provides that “Not more than 25 percent of the total roof area or roof section of any existing building or structure shall be repaired, replaced, or recovered in any 12-month period unless the entire roofing system or roof section conforms to requirements of this code.” Therefore, when more than 25% of the roof is damaged, as is the case here, code requires replacement of the roof. Additional damages to the property occurred such as damage to the foundation form intrusion, damage to the interior of the property for drywall and ceiling damage and mold. And finally, the fence structures of the property were severely damaged. All of these damages were so severe that each area of damage requires complete replacement rather than repair. Insurer issued a policy of insurance which inured to the benefit of Insured, Daniel Boyd. The insurance policy provided property insurance for the Insured’s home located at 1632 Grove Ave., Fort Myers, FL 33901-7822. The policy provides insurance coverage for all of the losses, damages and expenses that Insured suffered and incurred with regard to the subject loss, including Complainant's fees, charges and amounts owed for its necessary roof and/or mitigation services. Complainant provided Insurer with prompt and timely notice of the claim and the estimate. Complainant’s estimate is reasonable and necessary to place the property back into its pre-loss condition, which the Insurer is required to do under the policy. Complainant’s only option is to hire an attorney to file a lawsuit to compel Insurer to pay all insurance proceeds due and owing. The Insurer continues to take the position that it should not pay proceeds due and owing despite having received the Insured’s estimate, photographs, having inspected the property, and despite being presented with clear evidence of damage to the Insureds’ residence caused by hurricane/windstorm damage. Insurer willfully and wantonly breached its duty of good faith and standard of care owed to Insured and breached all applicable ethical codes governing public adjusting. First, the profession of adjusting insurance claims involves a special relationship of trust with the public. Insurance adjusters and insurance company claims representatives owe a duty of good faith claims conduct to an insured and/or the assignee of a claim. Insurer breached this duty by its improper adjustment of Complainant’s claim for assigned benefits in connection with an insured that suffered sudden and severe hurricane damage to its property. The Insured, after paying premiums and expecting protection against a loss, is in an especially vulnerable economic and personal position when an unexpected loss occurs. The entire purpose of insurance is defeated if those involved with insurance adjustment can refuse or delay the prompt and full payment of monies due under the contract. Because insurers enjoy an advantage and bargaining power through an insurance contract, which is arguably an adhesion contract, insurers are held to a higher standard of care. When an insurance company issues an insurance policy to an insured, it promises to provide financial security in the event of damage to the insured’s home. When a covered loss occurs, the insurance company’s obligation under its promise to pay is triggered. The policyholder is completely dependent on performance by the insurance company when the insured is at its most vulnerable position after a loss. The claim representative’s chief task should be to seek and find coverage, not to seek and find coverage controversies or to delay, deny, dispute or underpay insurance benefits. When an insurance company fails to pay claims it owes or engages in wrongful practices, contractual damages alone are inadequate. It is hardly a penalty to require an insurer to pay an insured (or the assignee of an insured) what it owed all along. Accordingly, the Florida legislature addressed the need for a bad faith action against an insurer in §624.155, Fla. Stat.; Complainant adopts and incorporates all provisions of that statute into this Civil Remedy Notice including all of the applicable provisions of §624.155(1)(i). It is far more profitable for an insurance company to take in an insured’s premium and not pay, rather than to promptly and fully pay what is owed. In this case, Insurer accepted contractually-required premiums, refused and failed to investigate and to adjust properly the claim, and failed to timely pay all proceeds due to the reasonable repair estimate. Therefore, Insurer breached its duty of good faith and standard of care to the Insured and to Complainant. Second, the State of Florida implemented codes of ethics and good faith duties articulated in the Florida Administrative Code. Insurers and their representatives must follow these ethical duties. Insurer violated the ethical requirements set forth in the 4-220.201 of the Ethical Requirements as follows in its adjustment of the Complainant’s claim for insurance benefits: “… a) The work of adjusting insurance claims engages the public trust. An adjuster must put the duty for fair and honest treatment of the claimant above the adjuster’s own interests, in every instance. b) An adjuster shall have no undisclosed financial interest in any direct or indirect aspect of an adjusting transaction… c) An adjuster shall treat all claimants equally; an adjuster shall not provide favored treatment to any claimant. An adjuster shall adjust all claims strictly in accordance with the insurance contract. … f) No adjuster may advise a claimant to refrain from seeking legal advice, nor advise against the retention of counsel to protect the claimant’s interest. … i) An adjuster shall not knowingly fail to advise a claimant of their claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state… j) An adjuster shall approach investigations, adjustments, and settlements with an unprejudiced and open mind. k) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. l) An adjuster shall handle each and every adjustment and settlement with honesty and integrity and allow a fair adjustment or settlement to all parties without remuneration to himself except that to which he is legally entitled. m) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition thereof. n) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and acknowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.” Further, Insurer failed to create and implement adequate guidelines for proper investigation and evaluation of damage claims brought under an AOB and for training and supervision of employees and adjusters resulting in statutory violations as set forth above. Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate Complainant’s claim for damage insurance benefits. Notwithstanding Complainant’s timely notification to Insurer of its claim and all documentation necessary for Insurer to fully investigate the insured’s damage claim, Insurer has delayed in paying or tendering to Complainant all assigned benefits due and owing under the assignor’s policy. Insurer has failed to promptly settle Complainant’s claim for assigned benefits when the obligation to settle became reasonably clear. To date, Insurer has continued to refuse to acknowledge its obligation to tender all monies due and owing to Complainant. No law or statute indicates that an insurance company’s good faith obligations are severed by litigation and there is nothing in the bad-faith statute that limits the bad faith penalty to pre-litigation events. Hurricane Ian made landfall on Florida’s coast and Insurer has refused and/or failed to settle the Complainant’s claim for assigned benefits under Insured’s policy when under all circumstances it could and should have done so had it acted fairly and honestly towards Complainant. Section 624.155(5), Fla. Stat., specifically exposes insurers to the risk of punitive damages should a jury conclude that the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (1) willful, wanton and malicious; or (2) in reckless disregard of the rights of its insured. Should discovery reveal that the Insurer’s bad-faith conduct, as referenced above, is a general business practice frequently implemented by Insurer against other insureds, which was done intentionally or in reckless disregard to the insureds’ rights, the insureds will seek an award of punitive damages from the jury. Insurer may cure this demand/notice within the statutory period by paying: (1) the sum of $43,909.91, plus accruing interest, for the replacement cost damages necessary to return the property to its pre-loss condition; (2) $30,000.00 in settlement of Complainant’s bad faith claim; and (3) $35,000.00 in attorney’s fees and costs.
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 02-24-2025 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainant: Daniel Boyd Policyholder: Daniel Boyd Filer: Alex Finch, Esq. Claim #: FPI235090 Policy #: FPH5350176-01 Date of Loss: September 28, 2022 CRN Filing No.: 798545 CRN Filing Date: December 29, 2024 To Whom It May Concern at The Department of Financial Services: With this correspondence, Florida Peninsula Insurance Company (“FLORIDA PENINSULA”) responds to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Alex Finch, Esq. on behalf of Daniel Boyd (the “Complainant” or “Claimant”). After reviewing the CRN, FLORIDA PENINSULA conducted a thorough review of its handling of the Complainants’ claim. FLORIDA PENINSULA denies that it has violated any of the statutes referenced in the CRN. At all times, FLORIDA PENINSULA has acted in good faith, fairly and honestly toward the Complainants and with due regard for their interests. FLORIDA PENINSULA also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information such as facts and circumstances which would allow FLORIDA PENINSULA to correct the alleged violations. The Complainants allege violations of 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. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute. 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 on portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. FLORIDA PENINSULA denies the allegations that it violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute; moreover, this statute has no nexus to the subject claim or the facts at hand. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute. 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. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute. 627.7283(1): If the insured cancels a policy of motor vehicle insurance, the insurer must mail the unearned portion of any premium paid within 30 days after the effective date of the policy cancellation or receipt of notice or request for cancellation, whichever is later. This requirement applies to a cancellation initiated by an insured for any reason. FLORIDA PENINSULA denies the allegation that it violated the above referenced statute. FLORIDA PENINSULA specifically denies each and every one of the Complainants’ allegations that it violated any of the above referenced statutes. In addition to the allegations specifically denied above, FLORIDA PENINSULA generally denies all allegations presented in this CRN as FLORIDA PENINSULA has not violated any statute or rule. CRN MUST BE DISMISSED As a preliminary matter, the CRN must be dismissed because the CRN is defective and fails to comply with the requirements for a property CRN, such as the requirements for specificity with actual and accurate facts in support of any of their statutory allegations. Next, the CRN requires that the Complainant “pursuant to section 624.155, F.S., please indicate all statutory provisions alleged to have been violated.” The CRN filed in this matter includes almost every statutory provision without consideration to the facts of the claim and regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the Civil Remedy Notice failed to allege any specific facts and/or circumstances in support of the allegations, FLORIDA PENINSULA is unable to properly respond; as such, the CRN should be rejected and returned. The CRN is wholly devoid of any factual allegations or any reference to communications (or lack thereof) possibly giving rise to any alleged violation. See Rousso v. Liberty Surplus Ins. Corp., No. 10-cv-20554, 2010 WL 7367059, at *4 (S.D. Fla. Aug. 13, 2010) (“In this case, the Plaintiffs do not explain how or identify which claims or suits the Defendant responded to in a manner that was contrary to good faith, unfair, or dishonest. This vagueness continues in the Plaintiffs' claim that the Defendant failed to respond to repeated pleas for assistance.”). These glaring deficiencies fail to apprise FLORIDA PENINSULA of the nature of any purported violation and cannot satisfy the statutory standard of “pleading the facts and circumstances” giving rise to the violation with specificity. The CRN first identifies Section 624.155(1)(b)(1), Florida Statutes, which addresses an insurer’s refusal to attempt to settle in good faith. The CRN, however, does not specify the nature of the underlying claim(s), or the circumstances supporting the conclusion that the unspecified refusal to settle was not in good faith. FLORIDA PENINSULA investigated the property and issued payment for covered damages on the property. To the extent the CRN suggests that FLORIDA PENINSULA should tender additional payment on the claim, the CRN fails to provide a sufficient description of the facts and circumstances supporting this contention. As to Section 624.155(1)(b)(3), Florida Statutes, the CRN does not identify any facts to support that FLORIDA PENINSULA failed to promptly settle a claim under one portion of the policy in order to influence settlement under other portions of the policy. As to Section 626.9541(1)(i)(3)(a), Florida Statutes, the CRN does not describe any standards applicable to the investigation of the purported “claim” advanced by the Complainants, much less the facts and circumstances giving rise to the contention that FLORIDA PENINSULA failed to adopt or implement such standards. The general defects specified above again apply with particularity here because the CRN’s failure to describe the facts or circumstances of the claim precludes FLORIDA PENINSULA from evaluating what error, if any, allegedly occurred during the claim process. Complainants cannot possibly support the position that the claim was denied improperly because the CRN provides no description of the applicable policy provisions, the facts or circumstances of FLORIDA PENINSULA’s investigation, the disposition of the claim, or the facts and circumstances indicating FLORIDA PENINSULA’s investigation was in some way defective. Regarding the alleged violation of Section 626.9541(1)(i)(3)(b), Florida Statutes, the CRN fails to describe any "misrepresentation" or false statement relating to the facts of the claim or coverages at issue. As to Section 626.9541(1)(i)(3)(c), Florida Statutes, the CRN does not describe any standards applicable to the purported “claim” advanced by the Complainant, much less the facts and circumstances giving rise to the contention that FLORIDA PENINSULA failed to acknowledge and act promptly upon communications with respect to claim. As it relates to Section 626.9541(1)(i)(3)(d), Florida Statutes, the CRN does not describe any instances where FLORIDA PENINSULA denied the Complainants’ claim without conducting a reasonable investigation based upon available information. As it relates to Section 626.9541(1)(i)(3)(f), Florida Statutes, the CRN does not describe any instances where FLORIDA PENINSULA failed to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy for the coverage determination or offer of a compromise settlement. Regarding Section 626.9541(1)(i)(3)(g), Florida Statutes, the CRN does not describe any instances where FLORIDA PENINSULA failed to promptly notify the insureds of any additional information necessary for the processing of the claim. Finally, as to 627.7283(1), Florida Statutes, the CRN incorrectly refers to motor vehicle insurance when the policy of insurance for this claim is a homeowner’s insurance policy. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported and incorrect allegations with no basis in fact or circumstance. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit and FLORIDA PENINSULA denies each and every one. Additionally, the CRN fails to identify specific policy language relevant to an alleged violation. Blanket references to policy provisions and statutes without specification deem the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., (Fla. 4th DCA 2020). The Complainants failed to state the specific policy language relevant to any alleged violation. Thus, the CRN lacks even minimal specificity of policy language to support the allegations. The CRN asserts vague allegations against persons representing FLORIDA PENINSULA by including “ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEY’S AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY THE INSURANCE COMPANY INVOLVED WITH THE HANDLING AND/OR ADJUSTMENT OF THE CLAIM.” The allegations set forth in the CRN are denied as they are mere conclusory allegations unsupported by facts, devoid of logic and intended solely to tarnish FLORIDA PENINSULA’s name and reputation. FLORIDA PENINSULA, at all times, acted fairly, honestly and in good faith in its dealings with the Complainants. FLORIDA PENINSULA did not fail to promptly settle the claim or attempt to settle the claim in order to influence settlement under a different portion of the policy. FLORIDA PENINSULA at no time misrepresented any pertinent facts or insurance policy provisions. FLORIDA PENINSULA conducted a reasonable and prudent investigation of the claim and acted upon all communications from the Complainants. Finally, FLORIDA PENINSULA promptly and appropriately communicated with the Complainants and provided explanations for the actions and decisions that were made. FLORIDA PENINSULA retained a field adjuster and conducted an inspection of the subject property to investigate the Complainants’ claim. Thereafter, FLORIDA PENINSULA made a coverage decision. As it relates to the facts of the claim, FLORIDA PENINSULA received notice of the subject loss on or about November 16, 2022, which was alleged to have occurred on September 28, 2022. Specifically, it was alleged that there were damages to the property from Hurricane Ian. On December 1, 2022, an independent adjuster inspected the subject property on behalf of FLORIDA PENINSULA. Following the inspection, payment was issued for the covered damages found to the property pursuant to the terms and conditions of the Policy and the investigation. In addition to the inspection, to aid its investigation of the claim, FLORIDA PENINSULA requested information from the Insureds, including documentation to substantiate the reported cause of loss, the date of the reported cause of loss, and the Claimant’s claim for damages. After analysis of the subject Policy, and based on the above factual investigation, FLORIDA PENINSULA issued a coverage determination by letter dated December 3, 2022, and issued payment pursuant to the Policy for the subject claim. Moreover, FLORIDA PENINSULA’s letter outlined the basis for FLORIDA PENINSULA’s coverage determination which included relevant policy language and the estimate of covered damages. The correspondences were in writing and were promptly sent to the Complainant. The above demonstrates quite clearly that FLORIDA PENINSULA acted in good faith, acted fairly and honestly, acknowledged and acted promptly upon receipt of the claim, attempted to determine coverage for the claim pursuant to the terms of the policy, took reasonable steps to investigate the claim, communicated reasonably with the Complainants about the claim, and provided the Complainants a reasonable explanation for its actions. Clearly, FLORIDA PENINSULA conducted a an investigation into the subject claim and rendered its coverage decision based on the terms and conditions of the subject policy. Additionally, the CRN contains demanded “cures” for the alleged defects; however, the listed “cures” are improper pursuant to Florida case law, specifically the case of Talat Enterprises, Inc., v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1281 (Fla. 2000). The Talat case provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amount due to the insureds. Talat also commented that, "It naturally follows that for there to be a "cure," what had to be "cured" is the non-payment of the contractual amount due the insured. In the context of a first-party insurance claim, the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled....” As a result, only a demanded “cure” relating to the specific amount needed to repair covered damages is proper and legal – any remaining “cures” are improper remedies and contrary to Florida law. In closing, FLORIDA PENINSULA first believes that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida case law, and regardless of the rejection, FLORIDA PENINSULA denies all allegations contained in the CRN and submits that there are no violations. Mere disagreement as to the amount of coverage does not equate to bad faith. Evidently, this CRN was filed in bad faith, as it is being used as an improper mechanism designed solely for the purpose of intimidating FLORIDA PENINSULA into potentially overpaying the Insured. For the aforementioned reasons, FLORIDA PENINSULA categorically denies that it has acted with bad faith in connection with this claim. While this response is meant to be comprehensive, FLORIDA PENINSULA based the above-mentioned statements upon the limited information provided in the CRN and the information FLORIDA PENINSULA has been provided to date. If the Complainant feels that FLORIDA PENINSULA is not in possession of all the facts, please provide such additional information as soon as possible. Please note that FLORIDA PENINSULA’s response is not necessarily exhaustive and does not preclude the assertion of other valid reasons for seeking rejection and return of the CRN. Also, nothing in this letter, or any act or failure to act on the part of FLORIDA PENINSULA or any agent or representative of FLORIDA PENINSULA should 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 CRN. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Regards, /s/ Tanaz Salehi Tanaz Salehi, Esquire On behalf of Florida Peninsula Insurance Company
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