Civil Remedy Notice of Insurer Violations
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Filing Number:     799569
Filing Accepted:  1/7/2025
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Complainant
Last/Business Name *  
HEATHER   First Name   ALEXIS
Street Address * 720 W 14TH ST.
City, State Zip * ATLANTIC BEACH, FL 32233
Email Address * ROBERT@WINDLAWGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HEATHER   First Name   ALEXIS
Policy # * OL30184229-07 Claim #* 23FLHOV0014100
Attorney
Attorney is Applicable
Last Name* GALLAGHER First Name * ROBERT Initial
Street Address* 8570 STIRLING RD., SUITE 102-406
City, State Zip* HOLLYWOOD , FLORIDA 33024
Email Address * ROBERT@WINDLAWGROUP.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):* THE ASSIGNED DESK ADJUSTER, FIELD ADJUSTER, SUPERVISOR(S) AND/OR MANAGER(S); AND ANY OTHER INDIVIDUAL THAT HAS REVIEWED THIS CLAIM OR MADE DETERMINATIONS WITH RESPECT TO THIS CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

OLYMPUS INSURANCE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, OLYMPUS INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections, all endorsements and changes to the subject policy are relevant to the insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about December 3, 2023, while the insurance policy (Policy Number: OL30184229-07) was in full force and effect, the subject property located at 720 W 14TH ST. ATLANTIC BEACH, FL 32233 sustained a covered loss as a result of water damage from a covered loss. The insured filed a claim (Claim Number: 23FLHOV0014100) per the terms of the insurance policy with OLYMPUS INSURANCE COMPANY (the “carrier”). OLYMPUS INSURANCE COMPANY received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. The carrier’s adjuster did not properly adjust the loss to include obviously related damages resulting from a covered loss. After the carrier’s inspection, OLYMPUS INSURANCE COMPANY opened coverage for the loss and offered an amount below deductible to repair all the damages. This amount is a gross under-valuation of the claim and is not close to what is needed to restore the subject property to its pre-loss condition, even when accounting for the deductible and depreciation. The insured retained a representative, who performed a comprehensive investigation of the subject property that identified the damage that the carrier knew existed but failed to address. The insured’s representative determined there were damages and repairs necessary to restore the property to its pre-loss condition and submitted claim-related documentation to OLYMPUS INSURANCE COMPANY, including a detailed estimate for repairs for $70,582.02. After offering its initial payment, OLYMPUS INSURANCE COMPANY made it clear that it had no intention of dealing fairly with the insured and properly addressing the gross discrepancy between its offer and the insured’s estimate. Once it became abundantly clear that OLYMPUS INSURANCE COMPANY had no intention of acting in good faith, the insured was forced to file the instant Civil Remedy Notice. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of OLYMPUS INSURANCE COMPANY have approached this investigation in a manner prejudicial to the insured. OLYMPUS INSURANCE COMPANY is using either untrained or improperly trained adjusters in connection with this claim. OLYMPUS INSURANCE COMPANY should have been fairly adjusting this claim, but instead, it was looking for ways not to pay the claim at all or not pay the claim in full. The above are all examples of OLYMPUS INSURANCE COMPANY’S unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. These actions demonstrate the carrier is 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 the insured. The insured gives this notice to perfect the right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: (1) Pay the complete covered loss in the amount of $70,582.02, less any prior payments and less any applicable policy deductible; (2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and (3) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim.
Comments
User Id Date Added Comment
bgarofalo@bressler.com 02-13-2025 Via U.S. Mail, Certified Mail and E-mail: ROBERT@WINDLAWGROUP.COM Robert Gallagher, Esq. The Wind Law Group, PLLC 8570 Stirling Rd., Suite 102-406 Hollywood, FL 33024 Complainant(s): Alexis Heather Policy #: OL30184229-07 Claim #: 23FLHOV0014100 DFS Filing #: 799569 Dear Mr. Gallagher: Please accept this response on behalf of Olympus Insurance Company (hereinafter “Olympus”) to the Civil Remedy Notice of Insurer Violations (hereinafter “CRN”) No. 799569, filed on behalf of Alexis Heather (hereinafter, the “Complainant” or the “Insured”), and accepted by the Florida Department of Financial Services on January 7, 2025. The Civil Remedy Notice (“CRN”) alleges that Olympus violated the following statutes: • 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)(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. Please accept this as Olympus’ response to the above-referenced CRN filed with the Department of Financial Services by the Complainant, Alexis Heather. To summarize the below, Olympus hereby denies any allegation of not attempting to settle claims in good faith when it could and should have done so; failing to adopt and implement standards for the proper investigation of claims; and misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue, and states that it has at all times handled and adjusted the Complainant’s claim with utmost good faith. Simply put, Olympus denies any acts or omission that could be construed or found to be deemed bad faith and/or a violation of Florida Statutes § 624.155 and § 626.9541, whether expressly stated in the Civil Remedy Notice or implied. Any and all allegations of bad faith are hereby denied and rejected in their entirety by Olympus. Beyond Olympus’ adamant belief that it acted with the utmost good faith, the CRN is deficient and fails to preserve any and all claims for statutory bad faith under Florida Law. As an initial matter, Olympus denies and rejects the instant CRN as it fails to comply with the requirements of Florida Statute § 624.155. The CRN is therefore deficient and fails to preserve any and all claims for statutory bad faith under Florida Law. Florida Statute § 624.155 requires a complainant to file with the Department of Financial Services a Civil Remedy Notice which shall be “on a form provided by the [Department] and shall state with specificity…such other information as the Department may require.” The Department created a CRN form, Form DFS-10-363, which lays out 15 requirements, including in part, the Complainant’s e-mail address, Complainant type, claim number, attorney’s name, attorney’s address, attorney’s e-mail address, type of insurer, the person with knowledge of the facts giving rise to the allegations, and the reason for notice. According to § 624.155, these mandates are required by the Department, and they must be stated with specificity. The instant CRN fails to provide the specificity required by § 624.155 and fails to comply with the form requirements. Therefore, the instant CRN is facially deficient. See Bay v. United Servs. Auto. Ass’n, No. 4D19-3332, 2020 WL 6154256 (Fla. 4th DCA Oct. 21, 2020). Specifically, the instant CRN filing makes no attempt to respond to one of the Department’s prompts and does not even include the name of a person when asked to “Please identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in this notice.” Rather, the Complainant states that “[the assigned desk adjuster, field adjuster, supervisor(s) and/or manager(s)…]” are the person(s) representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in this notice.” Whether the Complainant misread the Department’s prompt or simply dismissed what the Department had asked of him, the Complainant’s failure to comply with the requisite baseline form requirements is insufficient under Florida law to support any action for bad faith against Olympus without speculation on its part. Additionally, the instant CRN filing lists the Complainant’s e-mail address as “ROBERT@WINDLAWGROUP.COM,” the same e-mail address listed for the Complainant’s attorney and obviously not the Complainant’s true e-mail address. Withholding the Complainant’s e-mail address, and/or including the same one for the Complainant as for their counsel, provides separate and equally valid grounds for dismissal of the instant CRN as the Complainant has failed several times to comply with the Department’s basic form requirements. Due to this intentional withholding of mandated information, the CRN is facially deficient as it fails to comply with the form requirements set forth in Florida Statute § 624.155, and specifically § 624.155(3)(b)(3). See Bay v. United Servs. Auto. Ass’n, No. 4D19-3332, 2020 WL 6154256 (Fla. 4th DCA Oct. 21, 2020). Furthermore, the CRN’s attempt to identify the specific policy language relevant to the violation is woefully deficient. “Courts have found that listing whole sections of the insurance policy constitutes insufficient specificity.” See Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294 at *2 and Julien v. United Property & Casualty Insurance Company No. 4D19-2763 (Fla. 4th DCA 2020).” When prompted to reference the policy language that is relevant to the alleged violation, the Complainant makes absolutely no effort to provide the relevant policy language. Instead, the Complainant provides its own interpretation of the Complainant’s position, and the policy language associated with same. The Complainant entirely fails respond to the Department’s prompt, again dismissing the mandated information needed to submit a valid CRN against an insurer. The Complainant fails to provide any policy language at all, and instead lists the names of entire sections contained within the policy. The Complainant writes, “[Olympus] failed to adequately adjust and pay the claim covered under the subject insurance policy… [Olympus] failed to properly apply the Loss Settlement and Loss Payment provisions of the policy…” Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Florida Statute § 624.155. Julien v. United Property & Casualty Insurance Company No. 4D19-2763 (Fla. 4th DCA 2020). Failure to provide specific reference to any relevant policy language is direct and clear noncompliance with the requirements of Florida Statute § 624.155, and therefore renders the CRN deficient on its face as to form and substance. For these reasons alone, the CRN fails at its inception. Additionally, the CRN fails to provide a complete description relating to the facts and/or circumstances which give rise to the alleged statutory violations, thus, prejudicing Olympus from providing any meaningful or complete response. In summary, the CRN is hardly more than a recitation of several Florida statutory provisions, with minimal factual allegations in support of the conclusory statutory recitations. A Civil Remedy Notice must state the facts and circumstances that give rise to an alleged violation with specificity sufficient to allow an insurer to cure the alleged violation within the sixty-day statutory period. Lane v. Westfield Insurance Company, 862 So.2d 774 (Fla. 5th DCA 2003). The instant CRN therefore fails to comply with the requirements of Florida Statute § 624.155(3), which requires that a CRN of insurer violation “state with specificity,” inter alia, the facts and circumstances giving rise to the violation and the “specific” language of the subject insurance policy that is relevant to the violation. The CRN fails to specify what was lacking in Olympus’ investigation and fails to specify facts which support that its investigation was unfair or merits additional steps. To Olympus’ knowledge, the instant claim for insurance benefits has been adjusted and/or investigated properly. The CRN further lacks any specificity, facts, or rationale which indicate that Olympus’ coverage determination should have been different. Generally, the CRN lacks the requisite facts and/or specificity, as ruled on numerous times and cited to throughout this Response, to put Olympus on notice as to the allegations against it. Moreover, the few facts that are stated in the CRN are contrary to the facts of the underlying claim or are at best misleading. The CRN states that “[Olympus] received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. [Olympus]’s adjuster did not properly adjust the loss to include obviously related damages resulting from a covered loss.” However, these statements are false and meritless. Also, the CRN claims that, “[Olympus] is using either untrained or improperly trained adjusters in connection with this claim.” Again, this statement is untrue and unfounded. Rather, Olympus received notice of the insured’s claim on December 28, 2023, approximately one month after the purported date of loss. Olympus then inspected the property with both an independent licensed engineer and an independent licensed roofer. Based on these inspections Olympus determined that there was no storm related damage to the roof system but found coverage for ensuing water damages to the interior of the property. Olympus then invoked its contractual right of “Option to Repair” via written correspondence. This letter opened coverage for the interior damages and pursuant to the Policy’s terms, elected to perform the repairs to the interior through a vendor rather than issue a payment to the Insured. In the time that followed, the Insured and their representatives failed to comply with Olympus’ requests for compliance, as Olympus and its vendor require work authorization and other documents to initiate the necessary repairs to the property. Olympus has been unable to complete the repairs based on the insured’s lack of cooperation. Additionally, a letter of denial was issued explaining that the independent licensed engineer found no wind damage to the roof, and instead found that the source of the leakage was caused by age related deterioration around the alley of the roof and defects to the solar panel installation on the roof. The Complainant has provided no facts or evidence to support their allegations in support of the instant CRN or in any other context throughout the entirety of their claim. Olympus promptly and thoroughly investigated the subject claim and reached its coverage determination based upon its complete understanding of the facts. Olympus has repeatedly attempted to work with the insured Complainant to resolve their claim and restore their property. It is the Complainant who is not complying with the policy’s terms and as is clear from this CRN, there are no facts supporting the claims made against Olympus. The subject CRN makes egregious and baseless allegations that “After offering its initial payment, [Olympus] made it clear that it had no intention of dealing fairly with the insured and properly addressing the gross discrepancy between its offer and the insured’s estimate. Once it became abundantly clear that [Olympus] had no intention of acting in good faith, the insured was forced to file the instant [CRN],” and “Since the beginning of this claim the representatives on behalf of [Olympus] have approached this investigation in a manner prejudicial to the insured.” These are serious blanket allegations made without one scintilla of factual evidence in support of any of such claims. As demonstrated by the facts outlined above, Olympus diligently investigated the subject loss, repeatedly and routinely communicated with the insured Complainant, and acted accordingly based upon the facts it discovered throughout its investigation of the claim and according to the terms of the insurance contract. Olympus’ investigation of the subject claim was swift and routine: Olympus received a claim for damages, Olympus sent qualified representatives to inspect the property, Olympus reviewed the representative’s observations and/or conclusions and applied the relevant policy language thereto, ultimately resulting in an acknowledgement of some covered interior damages, for which Olympus chose to repair the damage with a preferred contractor. The Complainant’s cure demand is indiscernible and as such Olympus is not given a fair opportunity to cure the CRN. The CRN states: “… [t]o cure the defects outlined in this [CRN], [Olympus] must: (1) Pay the complete covered loss in the amount of $70,582.02, less any prior payments and less any applicable policy deductible; (2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and (3) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim.” This is the functional equivalent of “Pay me everything I’ve asked for.” Rousso v. Liberty Surplis Ins. Co., 2010 WL 736059, *5 (S.D. Fla. 2010). “Insurers are not required to pay any amount demanded by their insureds to avoid a bad-faith claim.” Id. (citing 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1194 (N.D. Fla. 2008)). However, regardless of its legitimacy, the CRN itself contains a cure in the form of an admission of liability and Olympus cannot even begin to attempt to cure the instant CRN on such unclear terms. In addition to demanding “everything I’ve asked for,” the cure is unclear as to what it’s asking for beyond the stated monetary amount. The cure provides no basis for Olympus to even attempt to calculate what it seeks when demanding several unclear payments and reimbursements to the insured Complainant, and then some unknown amount of interest purportedly owed on top of those indeterminate payments. Rather, the cure demand is merely an attempt to deceive Olympus into issuing some ambiguous payment rather than defending itself against a threat of bad faith when no bad faith is remotely existent anywhere throughout the instant claim. Given the cure, Olympus affirmatively asserts that the CRN is deficient. Since no other distinct basis for a cure has been set forth by the Civil Remedy Notice, Olympus was not provided with a reasonable opportunity to purge any alleged violations. See Kafie v. NorthWestern Mut. Life Ins. Co., 834 F. Supp. 2d 1354, 1359 (S.D. Fla. 2011) (“In order to demonstrate good faith, ‘[t]he insurer must investigate the facts, [and] give fair consideration to a settlement offer that is not unreasonable under the facts…’”). Based on the facts provided, it is impossible for Olympus to satisfy the Complainant without significantly prejudicing itself, and therefore the CRN fails to provide a true and feasible cure method. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Florida Statute § 624.155. Similarly, for these reasons, the CRN fails. As outlined above, contrary to the allegations made by the CRN, Olympus sufficiently and diligently investigated the loss. Olympus maintains that it has acted fairly and honestly toward the Complainant, and any other person having an interest in the subject policy or assisting the Complainant in connection with the instant claim. Olympus consistently and promptly communicated with the Complainant and/or their agents throughout all stages of the investigation and conducted a thorough investigation in good faith. To the extent that the instant CRN is intended to address any other facts or circumstances which purport to establish additional coverage for the reported losses, the CRN provides insufficient identification of any such facts or circumstances and therefore prevents Olympus from addressing any other aspect herein. Notwithstanding, Olympus believes that the above facts demonstrate beyond dispute that it has at all times acted in good faith with regard to its investigation of the subject claim, and further believes that the facts provided to date fail to establish that it has not adjusted the reported loss in accordance with the express terms, provisions, limitations and exclusions contained within the policy. If we can provide any additional information, or be of any further assistance, please do not hesitate to contact us at your earliest convenience. Very truly yours, /s/ Bruno A. Garofalo, Esq. _ Bruno A. Garofalo, 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