Civil Remedy Notice of Insurer Violations
Login

Filing Number:     799548
Filing Accepted:  1/6/2025
         Print Filing
Complainant
Last/Business Name *  
UNITED CAPITAL INVESTMENTS, LLC   First Name  
Street Address * 258 E ALTAMONTE DRIVE, SUITE 1001
City, State Zip * ALTAMONTE SPRINGS, FL 32701
Email Address * DRSEIFERTSCLINICS2022@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   UNITED CAPITAL INVESTMENTS, LLC   First Name  
Policy # * BPP11783 Claim #* 01-005-298542
Attorney
Attorney is Applicable
Last Name* DUNNAVANT First Name * ERIN Initial E
Street Address* 901 W SWANN AVE
City, State Zip* TAMPA , FLORIDA 33606
Email Address * SERVICE@DANDDLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   MAIN STREET AMERICA PROTECTION INSURANCE COMPANY
NAIC Company Code 13026
 
Name of individual responsible for violation (if any):* CLAIMS DEPARTMENT, SUPERVISORS, MANAGEMENT, AGENTS, AND ADJUSTERS, INCLUDING THE FOLLOWING REPRESENTATIVE & ADJUSTER(S) AND VENDORS SPECIFICALLY: LETRESHA ELKINS
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Violation of Code of Ethics
Other : Litigation Strategy and Behavior
* 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)(d) Denying claims without conducting reasonable investigations based upon available information.
* 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 Insured believes the following policy language is pertinent to its claim: SECTION I – PROPERTY – DECLARATIONS … COVERAGE LIMIT VALUATION BUILDING $ 1,102,500 REPLACEMENT COST … BUSINESSOWNERS COVERAGE FORM SECTION I – PROPERTY … A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. 1. Covered Property Covered Property includes Buildings as described under Paragraph a. below, Business Personal Property as described under Paragraph b. below, or both, depending on whether a Limit of Insurance is shown in the Declarations for that type of property. Regardless of whether coverage is shown in the Declarations for Buildings, Business Personal Property, or both, there is no coverage for property described under Paragraph 2. Property Not Covered. a. Buildings, meaning the buildings and structures at the premises described in the Declarations, including: (1) Completed additions; (2) Fixtures, including outdoor fixtures; (3) Permanently installed: (a) Machinery; and (b) Equipment; (4) Your personal property in apartments, rooms or common areas furnished by you as landlord; (5) Personal property owned by you that is used to maintain or service the buildings or structures or the premises, including: (a) Fire extinguishing equipment; (b) Outdoor furniture; (c) Floor coverings; and (d) Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering; (e) Alarm systems. (6) If not covered by other insurance: (a) Additions under construction, alterations and repairs to the buildings or structures; (b) Materials, equipment, supplies and temporary structures, on or within 1,000 feet of the described premises, used for making additions, alterations or repairs to the buildings or structures. … 5. Additional Coverages Unless otherwise stated or excluded in the Declarations, the following Additional Coverages apply and are in addition to the applicable Limits of Insurance. a. Debris Removal (1) Subject to Paragraphs (3) and (4), we will pay your expense to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. In addition, the Insurer has cited to the following policy language as being pertinent in its denial of coverage letter dated December 22, 2022. 4. Limitations a. We will not pay for loss of or damage to: … (5) The interior of any building or structure caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (a) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or (b) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building or structure. VIII. TO ENABLE THE INSURER TO INVESTIGATE AND RESOLVE YOUR CLAIM, DESCRIBE THE FACTS AND CIRCUMSTANCES GIVING RISE TO THE INSURER'S VIOLATION AS YOU UNDERSTAND THEM AT THIS TIME. In addition of the above statutory provisions alleged to have been violated, see also the following additional statutes and rules violated by Florida Peninsula: 624.155(1)(a)1 Any person may bring a civil action against an insurer when such person is damaged: (a) by violation of any of the following provisions by the insurer: (1) Section 626.9541(1)(i), (o), or (x) 69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the Insurance contract. 69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 69B-220.201(3)(j) An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract. 69B-220.201(3)(k) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. 626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state. 626.878 An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims. 624.155(5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (a) Willful, wanton and malicious; (b) In reckless disregard for the rights of any insured; or (c) In reckless disregard for the rights of a beneficiary under a life insurance contract.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Property located 258 E. Altamonte Dr., Suite 1001, Altamonte Springs, FL 32701, (“the Insured Property”) belonging to United Capital Investments LLC (“the Insured”) sustained damage resulting from Hurricane Ian on or about September 28, 2022. The Insured promptly reported the loss to its property insurer, Main Street America Protection Insurance Company (“Main Street”). Main Street’s mailing address is 55 West Street, Keene, New Hampshire 03431. Main Street’s home and administrative address is 4601 Touchton Road E., Suite 3400, Jacksonville, Florida 32246. The Insured Property is a multi-unit commercial building with multiple tenants. The Insured owns the subject property. On or about September 28, 2022, the Insured Property sustained damage as a direct result of Hurricane Ian. The Insured timely reported the loss to Main Street on or about October 3, 2022. On or about October 27, 2022, the Insured retained the services of public adjusting firm, S.E.P.I.A. Group LLC and public adjuster, Lauren Belloni (Keith) to further assist it with the proper adjustment of its claim with Main Street. On or about November 21, 2022, Main Street sent a field adjuster out to the Insured Property to conduct an inspection of the same. Ms. Belloni attended the inspection on behalf of the Insured. Following this inspection, on or about December 22, 2022, Main Street sent correspondence to the Insured wrongfully denying its claim. In particular, Main Street asserted that its field adjuster “found no damage to the roof, nor storm created opening which would contribute to the reported water damage to the interior.” And that in order for the policy to cover the loss there must first be “a storm created opening for coverage to be extended…” Suspect of Main Street’s coverage decision, the Insured decided to retain its own third-party vendors to conduct a separate inspection of the Insured Property to include an engineer’s report and a general contractors’ estimates. The Insured retained engineering firm, GCI Consultants, LLC (“GCI”) to inspect the Insured Property and prepare a report of findings and conclusions as to origin, causation, and damage of the Insured’s loss. Following its inspection, GCI prepared a report dated November 7, 2023, which determined in pertinent part as follows: IV. SUMMARY OF PRELIMINARY FINDINGS Based upon my research, document review, and observations at the site, along with my education, training, and experience, it is my opinion to a reasonable degree of engineering certainty that: A. Exterior Walls Most of the damage noted to the EIFS wall cladding is consistent with wind-borne debris impact which is caused when an object is picked up by the wind and makes contact with the exterior wall. Because the walls were recoated in 2018, it is likely that the damage was caused after that, and the most likely wind event since 2018 is Hurricane Ian. The damage to the EIFS has compromised the integrity of the wall cladding and can allow water infiltration into the wall system. Repairs are necessary to correct the damage. Localized repairs to the EIFS can be performed using a patch of like-kind material to tie into the existing wall cladding in accordance with standard EIFS repair methods. Care should be taken to ensure the repaired areas match the surrounding wall texture. Following the EIFS repairs, all wall surfaces should be recoated to conceal the repaired areas and restore the wall cladding to its pre-loss condition. The exterior walls should continue to be inspected, repaired, and recoated approximately every 5-10 years thereafter to ensure their continued performance. The damaged awnings should also be replaced. B. Windows There is widespread evidence of water intrusion around the windows at the property. The knowledgeable party interviewed has reported to me that the water intrusion was not occurring prior to Hurricane Ian. I observed damage to the windows which is consistent with wind-induced pressures. The damage includes the displaced window gaskets and damaged window sealants. Wind pressures acting on the windows can cause the windows to deflect in and out and cause the noted damage. The damage to the windows has compromised the water infiltration resistance performance of the windows and makes them more susceptible to water leakage during regular rain events. Repairs should be performed to all windows to reliably restore them to their pre-loss condition. Repairs should include repairing or replacing any damaged window gaskets, and re-sealing the exterior of the windows. All exterior metal-to-EIFS, metal-to-metal, and metal-to-glass joints should be completely sealed. I also recommend the bottom of the windowsill flashing is sealed to the EIFS (this condition is not related to Hurricane Ian). Sealants to the EIFS should be properly applied to the EIFS base coat in accordance with standard EIFS repair methods. The windows should be reinspected and repaired as necessary along with the exterior wall recoating every 5-10 years. The Insured also retained TRIAD Restoration Services (“Triad”) to inspect the property and prepare an estimate of damages on its behalf. Following its inspection of the Insured Property, Triad prepared an estimate dated July 9, 2024, (which incorporates the findings and conclusions of GCI) wherein it ascertained that it would cost approximately $152,748.31 (RCV) and $146,149.08 (ACV) to restore the Insured Property to its pre-loss condition. To verify that the numbers in TRIAD’s estimate were appropriate for this unique type of repair, in addition, the Insured hired Castle Group Construction who prepared an estimate dated December 13, 2024, for $81,200.00 as the costs necessary to fully and adequately address the damage sustained to the windows at the Insured Property. If you look at the Triad Estimate (with respect to the EIFS and Windows) and the Castle Group Construction’s estimate, they are within $2,500 of each other, showing the reasonableness of this quote. To date, despite evidence contrary to its decision, Main Street has not altered or revised its initial denial of coverage and has failed to pay insurance benefits clearly due and owing its Insured in regard to its Hurricane Ian loss. The Insured Property was damaged by a covered loss. The Insured timely reported the damage to Main Street, Main Street sent a field adjuster to inspect, and then the company incorrectly denied the claim. This is a breach of the contract by Main Street as to the insurance policy between it and the Insured. Main Street did not follow through with its obligations under said contract by failing to pay the claim. The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow specified amounts or a determinable benefit upon determinable contingencies. Inherent is the fact that payment is made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Main Street has failed to comply with its duty to indemnify the Insured. Main Street has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s claim for damages, resulting in a wrongful denial of coverage. Refusal and/or failure to settle the Insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrong. The actions taken by Main Street in the handling and adjustment of the Insured’s claim were willful, wanton, and in disregard for the rights of its Insured and occur with such a frequency as to indicate a general business practice, and further, are in violation of Florida Statutes § 624.155 and § 626.9541. Based on the foregoing actions and omissions, Main Street has engaged in wrongful claims handling conduct, including but not limited to, the following: 1. Improper claim delay. 2. Improper claim denial. 3. Not conducting a full and fair investigation of the Insured’s claim. 4. Looking for ways to delay recovery to the Insured. 5. Looking for ways to deny recovery to the Insured. 6. Not adjusting the claim and not evaluating the loss properly, promptly, and fairly so as to provide full and prompt indemnity to its Insured. 7. Failing to implement proper standards for the adjustment and investigation of insurance claims. 8. Making misrepresentations to the insured about the cause and scope of damages. 9. Making misrepresentations to the insured about the existence of coverage. 10. Making misrepresentations about facts. 11. Not training, supervising, or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed. 12. Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses. Therefore, to cure the defects outlined in this Civil Remedy Notice, Main Street must: Tender the full amount of insurance monies owed to the Insured for damages resulting from Hurricane Ian. A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice: Main Street America Protection Insurance Company, via Certified Mail, R.R.R. Letresha Elkins, Main Street America Protection Insurance Company, via US Mail. Claims Department, Main Street America Protection Insurance Company, via U.S. Mail. Walter Seifert and Sonia Seifert, via email. Lauren Belloni, SEPIA Group LLC, via email.
Comments
User Id Date Added Comment
tiyarollelaw@gmail.com 03-04-2025 LAW OFFICE OF REBECCA WOLTJER ALL ATTORNEYS AND STAFF ARE EMPLOYEES OF AMERICAN FAMILY INSURANCE CO., S.I. NOT A LEGAL PARTNERSHIP OR PROFESSIONAL CORPORATION PO BOX 77055 MADISON, WISCONSIN 53707 TELEPHONE: 800-692-6326 FACSIMILE: (844) 556-7209 Direct Dial No.: (305) 763-7321. EMAIL: tiya.rolle@amfam.com March 4, 2025 United Capital Investments, LLC c/o Erin E Dunnavant 901 West Swann Ave Tampa, FL 33606 service@danddlaw.com Re: Civil Remedy Notice Claim No.: 01-005-298542 Date of Loss: 9/28/2022 Insureds: United Capital Investments, LLC Policy No.: BPP1178J Dear Erin E. Dunnavant, We are in receipt of your Civil Remedy Notice of Insurer Violations (hereinafter “Notice”). Main Street America Protection Insurance Company (“MSA”) Insurance Company responds to the substance of your Civil Remedy Notice of Insurer Violations as follows: This correspondence will serve as the response of MSA to the Notice, DFS number 799548. MSA hereby responds to the factual assertions set forth in the Notice without waiving any rights under Florida law to object to the legal deficiencies and inadequacies of the Notice. In the Civil Remedy Notice, you have asserted the following as the reasons for filing the Notice – (1) Claim Denial, (2) Claim Delay, (3) Unsatisfactory Settlement Offer, (4) Unfair Trade Practice, (5) Violation of Code of Ethics, and (6) Litigation Strategy Behavior. You have also cited several sections of the Florida Statutes alleging, in part, that MSA has acted in bad faith and failed to settle the claim promptly. These allegations are broad and unspecified, to which a specific and detailed response is impossible given the vagueness of the allegations. Notwithstanding, MSA categorically denies these allegations both as to any general practice and with regard to this particular claim. Without waiving any rights under Florida law regarding the deficiencies and inadequacies of the Notice, MSA hereby responds to the assertions set forth in the Notice as follows: Response to Reason for Notice You state that the reasons for the Notice are due to the following: (1) Claim Denial, (2) Claim Delay, (3) Unsatisfactory Settlement Offer, (4) Unfair Trade Practice, (5) Violation of Code of Ethics, and (6) Litigation Strategy Behavior. MSA responds by stating that these allegations are without basis and are therefore denied. MSA further states that the alleged 09/28/2024 loss was first reported to MSA on 10/03/2022. The claim was investigated and ultimately it was denied. Additionally, a recent inspection from an engineer from Keystone Experts and Engineers, LLC confirmed that there was no wind damage to the roof. Response to Statutory Provisions Allegedly Violated The Civil Remedy Notice statute requires that a complainant “indicate all statutory provisions alleged to have been violated,” and you have listed several Florida Statutes. These allegations are overbroad and non-specific, apparently based upon conjecture or speculation to which a response is impossible given the uncertainty of the allegations. Notwithstanding, MSA categorically denies each alleged violations of statutes or rules asserted by you, both as to any general practice and with regard to this specific claim, as well. With respect to the statutes cited in this section of the Notice, MSA denies having violated the referenced statutes and responds to each of the alleged violations as follows. §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have been done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §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 denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. The Notice Fails to Reference Specific Policy Language The statutory provision governing Civil Remedy Notices requires complainants to “[b]riefly reference the specific policy language that is relevant to the violation, if any.” §624.155(3)(b)4, Fla. Stat. The Notice filed on your behalf fails to cite to a policy provision providing the specific language relevant to the violation. Essentially, you cite no policy language that supports any of the allegations made against MSA. A detailed and specific response to the cited policy language is impossible, given the vagueness of the allegations cited in the Notice. Notwithstanding, MSA has both a duty and a right to fully investigate this loss, which it did. MSA acted immediately upon Notice of the complainant’s claim. Response to Facts/Circumstances Cited as Giving Rise to Alleged Violation The governing statute requires Civil Remedy Notices to “state with specificity . . . [t]he facts and circumstances giving rise to the violation.” Fla. Stat. §624.155(3)(b)2. The Notice contains a section requiring the following: “To enable the insurer to investigate and resolve your claim, describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” However, the Notice lists alleged violations that are vague, overbroad and unsubstantiated that MSA is precluded from being able to respond in any specific manner. Nevertheless, MSA asserts that all actions that have been taken in responding to your claim have been performed properly, in good faith and for the purpose of reaching a fair and appropriate claim decision. MSA therefore denies all allegations set forth as the “facts and circumstances giving rise to the violations” in the Notice. MSA denies it has engaged in bad faith conduct in this matter. MSA denies any undue delay in adjusting the claim. MSA promptly and timely responded to the loss Notice and report of claim, retained an adjuster to assess the damages, and promptly began its investigation of the claim. MSA denies any allegation that it did not adopt or implement standards for proper investigation of the claim. MSA stands by its adjustment and investigative practices generally and the adjustment and investigation of this claim specifically. MSA has acted properly, promptly and in accordance with the terms of the policy of insurance and applicable law in the investigation of this claim. MSA asserts that all actions taken have been made in good faith and for the purpose of fair, equitable and timely resolution of this matter. MSA has acted appropriately at all times regarding the handling of this claim. MSA has not violated any applicable statutory provisions in relation to this claim and expressly denies all of the allegations set forth as the “facts and circumstances giving rise to the violations.” Conclusion MSA promptly investigated the claim, and contrary to the allegations in the Notice, the facts show that MSA has consistently complied with all legal and professional standards for the investigation and adjustment of this claim. MSA investigated and evaluated your claim pursuant to the policy of insurance and subject to the policy limitations, exclusions, forms and endorsements applicable to the policy and in accordance with Florida law. Notwithstanding the deficiencies in the Notice, MSA denies it violated the statutes cited in the Notice. MSA hereby denies each and every allegation contained in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of the subject claim. MSA has acted fairly and with due diligence throughout the entire investigation and handling of this claim. To the extent that this response does not fully address and respond to the allegations set forth in the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations contained therein. Contrary to the allegations in the Notice, MSA has fully complied with its obligations under Florida Statutes and the policy of insurance with regard to the investigation and adjustment of this claim. MSA categorically denies all allegations contained in the Notice. In sum, MSA has evaluated this claim in good faith and all allegations of violation are statutorily deficient and without merit. I trust that the foregoing, without waiver of arguments regarding the lack of validity of the Civil Remedy Notice of Insurer Violations, adequately addresses any concerns that the insureds may have regarding this matter. Please do not hesitate to contact the undersigned if you require more information. Respectfully submitted, /s/ Tiya Rolle Tiya Rolle, 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.

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