Civil Remedy Notice of Insurer Violations
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Filing Number:     798849
Filing Accepted:  1/2/2025
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Complainant
Last/Business Name *  
ACEVEDO   First Name   RAUL
Street Address * 9518 BRACKIN STREET
City, State Zip * ORLANDO, FL 32825
Email Address * LUCY.RIVERA0115@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ACEVEDO   First Name   RAUL
Policy # * 0760029925 Claim #* 7008050504-1
Attorney
Attorney is Applicable
Last Name* GUTIERREZ First Name * CAMILA Initial
Street Address* 5600 DAVIE ROAD
City, State Zip* DAVIE , FLORIDA 33314
Email Address * CGUTIERREZ@MINEOLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Violation of Code of Ethics
* 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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)(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.
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)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* 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 breach of the above statutory duties, see Coverage A and Loss Payment Provisions
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Truck Insurance Exchange (“the Insurance Company”) issued a homeowner’s insurance policy to its insureds, Raul Acevedo and Luz Rivera (the “Insureds”), for the insured’s property located at 9518 Brackin Street, Orlando FL, 32825. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about September 28, 2022 while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of Hurricane Ian. The Insured promptly notified the Insurance Company of the loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number 7008050504-1 to the loss. The Insureds complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts. The Insurance Company has inspected the property and conducted its investigation of the claim. The Insured has fully complied with all policy conditions and requests made to the Insureds by the Insurance Company, though the Insureds do not believe that the Insurance Company has conducted a full investigation and/or accurately conducted its investigation. After completing its investigation, the Insurance Company wrongly denied the Insured’s claim and failed to issue any payment for the claim whatsoever. In fact, the insurance company denied the claim on October 11, 2024, alleging no coverage for the claim. Accordingly, the Insurance Company has misrepresented facts and policy language related to the coverages provided under the policy, and has accordingly collected a premium for insurance that has not been provided in full. The obligation to pay the full value of the Insured’s claim has been made clear based on the facts and evidence available, yet the Insurance Company has failed to pay the full value of the Insured’s claim. This is caused in part by the Insurance Company’s failure to adopt and implement standards for the proper investigation of claims. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its’ Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or denying the claim in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. In order to remedy the above defects, the Insurance Company must do the following: 1. Immediately admit coverage and pay the Insureds the full value of the claim. 2. Pay statutory interest on the amount of unpaid damages from the date of loss. 3. Act fairly and honestly toward its Insureds with due regard for her interests in attempting to resolve the claim. 4. Cease and desist all present and future bad faith actions with regard to this claim. 5. Implement standards for the property investigation of claims. 6. Stipulate to the Insureds’ entitlement to attorney’s fees and court costs pursuant to section 627.428, Florida Statutes, and pay the amount of fees and costs incurred.
Comments
User Id Date Added Comment
aguevara@bankerlopez.com 01-08-2025 Re: Raul Acevedo Our client: Truck Insurance Exchange Policy No.: 0760029925 Claim No.: 7008050504-1 Dear Mrs. Gutierrez: The undersigned counsel and the law firm of Banker Lopez Gassler represent Truck Insurance Exchange “Truck” with regard to the above referenced claim. This shall serve as Truck’s Response to the Civil Remedy Notice (“CRN”) No. 798849, filed by your firm and/or on behalf of Rual Acevedo for the property located at 9518 Brackin Street, Orlando, Florida 32825. Raul Acevedo (“Complainant”) alleges that Truck violated various subsections within Sections 624.155 and 626.9541 Florida Statutes, pertaining to Claim No. 7008050504-1 under Complainant’s insurance policy with Truck bearing Policy No. 0760029925. Truck welcomes this opportunity to respond to the Notice and rejects all allegations therein that Truck or its agents violated any statutory or ethical obligation. This Notice fails to comply with the specific notice and information requirements as set forth in Section 624.155, Florida Statutes. A complainant wishing to avail itself of the statute’s benefits must strictly comply with its requirements. Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000); Florida Steel Corp. v. Adaptable Devs., Inc., 503 So. 2d 1232, 1234 (Fla. 1986). Section 624.155 of the Florida Statute requires that a CRN state “the statutory provision, including the specific language of the statute” that the insurer allegedly violated. One court found a CRN was invalid where it “quoted large portions of sections 624.155 and 626.9541(1)(i) but did not specify which subsections were at issue.” Heritage Corp. of S. Fla. V. Nat’l Union Fire Ins. Co. of Pitt., PA, 580 F. Supp. 2d 1294, 1299 (S.D. Fla. 2008), aff’d, 361 F. App’x 986 (11th Cir. 2010). The statute also requires that the CRN reference “specific policy language that is relevant to the violation, if any.” A CRN that includes a list of whole sections found in most insurance policies “appears to lack specificity.” Fox v. Starr Indemnity & Liability Co., No. 8:16-cv-3254-T-23MAP, 2017 WL 1541294, at *2 (M.D. Fla. Apr. 28, 2017). Here, the Notice fails to provide any policy language whatsoever. Therefore, the Notice does not comply with the policy language requirement set forth within Section 624.155 and 624.9541, Florida Statutes. Additionally, the statute requires specific information regarding the facts and circumstances giving rise to the violation. Courts interpreting this requirement have explained that the claimant must recite facts related to the insurer’s actions. See Heritage, 580 F. Supp. 2d at 1299. These facts should match up with statutory provisions claimed to have been violated and should explain how the insurer violated those statutes. Rousso v. Liberty Surplus Ins. Corp., No. 10-cv-20554, 2019 WL 7367059, at *4 (S.D. Fla. Aug. 13, 2019). “The CRN must reflect a good faith effort to inform the insurer of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings.” Id. At *5. While this Notice does list the statutory provisions that have been allegedly violated, the Notice fails to pair the statutory provisions with any facts or circumstances to explain how these provisions have been allegedly violated. Instead, the Notice contains paragraphs of boiler plate allegations and fails to match these allegations with any of the alleged violated statutory provisions. For these reasons, the Notice is defective in its entirety. Among the numerous unsupported allegations, one such example is that the Notice alleges Truck violated § 626.9541(1)(i)(3)(a) for failing to adopt and implement standards for the proper investigation of claims. However, the body of the Notice fails to describe how Truck allegedly failed to adopt or implement standards for the proper investigation of this claim. Claimant’s failure to provide any factual support for the alleged violations renders the Notice legally deficient and in violation of Florida Statute § 624.155(3)(b). The Notice states that in order to cure the alleged defects, Truck must pay the full value of the alleged claim, attorney fees, and statutory interest. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: “Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. Section 624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). . . . [t]o cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire.” Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). Thus, the CRN violates the law from Talat as it requires Truck do more than simply tender the contractual amount due. Throughout the claim process, Truck has been keenly aware of its obligations to its insured and has fully met those obligations. Truck has proceeded in good faith and has not violated the above-referenced statutes. While this response is meant to be comprehensive, Truck’s response is based upon the information provided in the Notice and the information known to date. This response should not be construed as a waiver of any rights or defenses, as all such rights and defenses are specifically reserved. Thank you for your time and attention. Please do not hesitate to contact my office should you wish to discuss. Sincerely, BANKER LOPEZ GASSLER, P.A. Amy Currotto Amy Currotto, Esq.
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