Civil Remedy Notice of Insurer Violations
Login

Filing Number:     799860
Filing Accepted:  1/8/2025
         Print Filing
Complainant
Last/Business Name *  
HOOD   First Name   BILL
Street Address * 16 PINE VALLEY CIR
City, State Zip * ORMOND BEACH, FL 32174
Email Address * FLAHOOD@AOL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HOOD   First Name   BILL
Policy # * 80-CX-E912-7 Claim #* 59-75P4-40P
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* SEAN CANADA, KEVIN MORTLEY, MATTHEW RIOFRIO, FRANK BARCLAY, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, STATE FARM FLORIDA INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
626.9541(1)(i)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement; Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

State Farm Florida Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) failing to provide an estimate that complies with the Florida Building Codes; 10) failing to provide a loss run statement; and 11) 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. On or about October 9, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by Hurricane Milton. The areas impacted include but are not limited to the laminate roofing system, the modified bitumen roofing system, solar heater, gutters, fence, back porch, and front porch. The Insured timely submitted a claim to the Insurer for hurricane damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 59-69X4-24Q to the loss and sent a field adjuster to inspect the property on December 2, 2024. Then in a letter dated December 26, 2024, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $2,882.88 to restore the insured property to its pre-loss condition. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer erroneously denied coverage for the Insured's roof damage. The claims determination letter failed to comply with Fla. Stat. 626.9541(1)(i)(3)(f) as it did not include a reasonable explanation of the basis in the insurance policy, in relation to the facts, for the denial. The letter simply copies several policy exclusions with no explanation. Given the partial denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from Hurricane Milton, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $53,561.94 in covered damage to the dwelling and $1,312.58 in damage to other structures. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's field adjuster observed damage to the roof but attributed the cause of this damage to causes excluded under the policy. However, the Insurer never retained a professional engineer to determine the cause of this damage. Instead, the Insurer relied upon the causation opinions of a lay witness who will likely testify during his deposition that the Insurer never retained him to provide any causation opinions. Rather, the Insurer defaulted to deny coverage by relying upon a faulty and inadequate investigation. Also, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. Lastly, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On December 11, 2024, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for the Insured's roof damage as well as wrongfully determining that it would only require $2,882.88 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Failing to provide an estimate that complies with the Florida Building Codes 10. Shifting the burden of investigating onto the Insured 11. Conducting inadequate investigations 12. Failing to provide a loss run statement 13. Making material misrepresentations 14. 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 Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: State Farm Florida Insurance Company 7401 Cypress Gardens Blvd. Winter Haven, FL 33888-0007 statefarmfireclaims@statefarm.com
Comments
User Id Date Added Comment
grant@krapflegal.com 07-07-2026 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice. This Civil Remedy Notice is hereby withdrawn.
Viktoria.Willette@kubickidraper.com 03-07-2025 March 7, 2025 VIA ELECTRONIC FILING THROUGH WWW.FLDFS.COM – CIVIL REMEDY SYSTEM And by electronic mail to: Bill Hood c/o Grant W. Krapf 2790 Sunset Point Road Clearwater, Florida 33759 grant@krapflegal.com CIVIL REMEDY NOTICE RESPONSE DFS File No.: 799860 Complainant: Bill Hood Insured: Bill Hood (The CRN only included Bill Hood, but this response is to both Insureds) Claim No.: 59-75P4-40P Policy No.: 80-CX-E912-7 Date CRN filed: January 8, 2025 Dear Sir or Madam: Undersigned counsel and the law firm of Kubicki Draper represent State Farm Florida Insurance Company (“State Farm”) with regard to the above-referenced claim. This shall serve as State Farm’s response to the “Civil Remedy Notice of Insurer Violations” (“CRN”), filed by or on behalf of Bill Hood with the Florida Department of Financial Services (“Department”) on October 3, 2024. While the CRN only included Bill Hood as the Complaint/Insured, Karen Ann Hood is also insured under the subject Policy. As such, this CRN Response is in reference to both Karen Ann Hood and Bill D. Hood (hereinafter “Complainants” or “Insureds”). State Farm responds to the CRN as follows. The CRN arises from alleged wind and hail damage reported to State Farm on October 18, 2024, that Complainants allege occurred as a result of Hurricane Milton on October 10, 2024 at Complainants’ property located at of 16 Pine Valley Circle, Ormond Beach, Florida 32174 (the “Property”). Upon receiving notice of the loss, State Farm promptly acknowledged, investigated and issued its coverage determination on Complainants’ claim as more fully described below. In their CRN, Complainants assert fourteen (14) allegations against State Farm: claim denial; claim delay; unfair trade practice; misrepresenting the terms of the insurance policy; not treating the Insured with good faith claims conduct; looking for ways to deny full recovery to the Insured; looking for ways to delay full recovery to the Insured; failing to properly investigate the Insured’s loss; failing to provide the Insured with the full benefits awarded under the contract of insurance; not training, supervising, or managing adjusters properly so that prompt and full payments are made; not adjusting claims and evaluating losses properly; shifting the burden of insuring the loss to the Insured; intentionally misstating the terms, conditions, and benefits of the insurance policy to the Insured; and failing to implement proper standard for the adjustment and investigation of claims. Complainants further allege State Farm has violated various provisions of sections 624.155 and 626.9541, Florida Statutes (2024) in handling the claim. Complainants contend State Farm did not attempt in good faith to settle their claim when, under all the circumstance, it could have and should have done so, had it acted fairly and honestly towards its insured and with due regard for his or her interest; made material misrepresentations to Insureds or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by such contract or policy; failed to adopt and implement standards for the proper investigation of claims; misrepresented pertinent facts or insurance policy provisions relating to coverage at issue; failed to acknowledge and act promptly upon communications with respect to claims; denied claims without conducting reasonable investigations based upon available information; failed 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. See CRN at 3 (citing §§ 624.155(1)(b)(1); 626.9541(1)(i)(2); 626.9541(1)(i)(3)(a); 626.9541 (1)(i)(3)(b); 626.9541 (1)(i)(3)(c); 626.9541 (1)(i)(3)(d); 626.9541 (1)(i)(3)(f). This is not so. State Farm has at all times handled this claim in good faith, and thus, respectfully and categorically denies without limitation each and every allegation contained within the CRN, including but not limited to the alleged violations of the cited provisions of Florida law. State Farm further denies any and all stated, implied, and/or unspecified allegations, including but not limited to denying any and all allegations of alleged improper claim handling, inadequate investigation, failure to communicate, misrepresentations, failure to settle in good faith, improper delay or denial, general business practices, and the like, whether or not specifically alleged by the CRN. As will be discussed herein, not only is the CRN riddled with defects and factual errors that render it totally invalid, but also, Complainants’ claims against State Farm are substantively without merit. Addressing first the CRN’s legal sufficiency, State Farm objects to the CRN based on multiple defects, which render the CRN invalid and legally insufficient. Specifically, the CRN fails to comply with section 624.155(3)(b), Florida Statutes, which requires the CRN to specify the facts and circumstances giving rise to the alleged violations, the statutory provisions allegedly violated, as well as the relevant policy language at issue in the alleged violations. All such requirements must be strictly construed and complied with, as a claim for first-party bad faith does not exist apart from the statute creating it. This was confirmed by the appellate court’s decision in Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021) (on rehearing), where the Fourth District affirmed that a CRN is invalid and precludes a future bad faith claim where, as here, it fails to strictly comply with the specificity and other requirements of section 624.155(3)(b). As will be discussed, the instant CRN’s failure to strictly comply with section 624.155(3)(b) likewise renders it invalid. Here, little—if anything—is stated with specificity as required by the statute. The CRN lists seven (7) statutory provisions State Farm allegedly violated; however, it offers no meaningful explanation as to how these provisions were allegedly violated or how they relate to the subject claim or the allegations of the CRN. State Farm responds to each individual violation as follows: • Section 624.155(1)(b)(1), Florida Statutes. Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its Insureds and with due regard for his or their interests. • Section 626.9541(1)(i)(2), Florida Statues. Committing or performing with such frequency as to indicate a general business practice any of the following: (2). A material misrepresentation made to an Insured or any other person have an interest in the proceeds payable under such contact 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. • Section 626.9541(1)(i)(3)(a), Florida Statutes. Committing or performing with such frequency as to indicate a general business practice any of the following: a. Failing to adopt and implement standards for the proper investigation of claims. • Section 626.9541(1)(i)(3)(b), Florida Statutes. Committing or performing with such frequency as to indicate a general business practice any of the following: b. Misrepresenting pertinent facts or Insurance policy provision relating to coverages at issue. • Section 626.9541(1)(i)(3)(c), Florida Statutes. Committing or performing with such frequency as to indicate a general business practice any of the following: c. Failing to acknowledge and act promptly upon communications with respect to claims. • Section 626.9541(1)(i)(3)(d), Florida Statutes. Committing or performing with such frequency as to indicate a general business practice any of the following: d. Denying claims without conducting reasonable investigations based upon available information. • Section 626.9541(1)(i)(3)(f), Florida Statutes. Committing or performing with such frequency as to indicate a general business practice any of the following: f. Failing to promptly provide a reasonable explanation in writing to the Insureds 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. State Farm responds to each individual violation as follows: • Section 624.155(1)(b)(1), Florida Statutes. Complainants provide no support for their allegation that State Farm did not attempt in good faith to settle the claim, and certainly no factual support that settlement was warranted “under all the circumstances” of this claim. Complainants dispute State Farm’s coverage decision, referencing the anti-concurrent cause doctrine, which does not apply. State Farm specifically denies this allegation. The inspection revealed covered damage to the pool enclosure screens, screen doors, and wood fence from October 10, 2024. However, the total damage did not exceed the $3,072 hurricane deductible, so no payment was issued. For the dwelling roof and exterior, no accidental direct physical loss was found—only wear, tear, and deterioration. Since coverage applies only to accidental direct physical loss, a disagreement with State Farm’s findings alone does not support a bad faith claim. • Section 626.9541(1)(i)(2), Florida Statutes. Complainants do not identify any “material misrepresentation” made by State Farm, much less do they elaborate what State Farm materially misrepresented to effect settlement “on less favorable terms” than provided by the policy, however, the covered damage fell below the deductible, so this statute is inapplicable. State Farm specifically denies this allegation. Additionally, State Farm's coverage letter detailed its inspection findings, explaining that the covered damage fell below the deductible and clarifying why the dwelling roof and exterior were not covered. This decision was supported by policy language. The fact that the total damage did not exceed the deductible and that additional damage was not covered is not a misrepresentation; rather, it reflects a difference in inspection findings, which does not constitute bad faith. • Section 626.9541(1)(i)(3)(a), Florida Statutes. In order to prove a violation under this provision of the law, Complainants must show State Farm commits this action “with such frequency to indicate a general business practice.” State Farm specifically denies this allegation. Complainants’ CRN contains no allegations regarding the frequency with which State Farm engages in this practice, nor does it assert that it rises to the level of a general business practice. Furthermore, Complainants fail to provide any details explaining how State Farm’s claim investigation standards are lacking or deficient. In fact, the body of the CRN does not mention State Farm’s investigation standards at all; it merely expresses dissatisfaction with the claim outcome. A difference in inspection findings does not constitute a basis for a bad faith claim. Complainants do not raise any additional concerns regarding State Farm’s investigation that would call into question the legitimacy of its findings. Accordingly, this does not constitute a violation of section 626.9541(1)(i)(3)(a). • Section 626.9541(1)(i)(3)(b), Florida Statutes. In order to prove a violation under this provision of the law, Complainants must show State Farm commits this action “with such frequency to indicate a general business practice.” State Farm specifically denies this allegation. Complainants’ CRN contains no allegations regarding the frequency with which State Farm engages in this practice, nor does it assert that it rises to the level of a general business practice. Moreover, the CRN fails to identify any pertinent fact or policy provision that State Farm allegedly misrepresented. Instead, in the policy section of the CRN, Complainants state that “the violations alleged are statutorily based and do not rely on any specific policy language.” See CRN at 3. As there is no policy reference within the CRN, this statute is inapplicable. • Section 626.9541(1)(i)(3)(c), Florida Statutes. In order to prove a violation under this provision of the law, Complainants must show State Farm commits this action “with such frequency to indicate a general business practice.” State Farm specifically denies this allegation. Complainants’ CRN does not allege that State Farm engages in this conduct frequently or that it constitutes a general business practice. Instead, it focuses on a single request made on December 11, 2024, for a Loss Run Statement, to which State Farm responded on January 15, 2025. While this response exceeded the 15-day period required under section 627.444, a one-time occurrence does not establish a general business practice under the statute. There is no evidence that State Farm engages in this conduct with sufficient frequency to suggest a pattern of noncompliance. Moreover, the facts of this claim demonstrate that State Farm was highly responsive to communications from Complainants and their representatives. State Farm promptly acknowledged the claim, coordinated a mutually agreeable inspection date with Complainants and their public adjuster, acknowledged the attorney’s letter of representation, issued a coverage determination, and responded to Complainants’ untimely sworn statement in proof of loss. There is no basis for Complainants’ assertion that State Farm’s communications were deficient, let alone that it engaged in bad faith. • Section 626.9541(1)(i)(3)(d), Florida Statutes. In order to prove a violation under this provision of the law, Complainants must show State Farm commits this action “with such frequency to indicate a general business practice.” State Farm specifically denies this allegation. Complainants’ CRN contains no allegations regarding the frequency with which State Farm engages in this practice, nor does it assert that it rises to the level of a general business practice. Furthermore, Complainants provide no support for their assertion and cannot claim that State Farm denied the claim without a reasonable investigation when their focus is solely on the outcome rather than the investigative process itself. State Farm did not issue a full denial of the claim but determined that a portion was not covered due to the absence of accidental direct physical loss. Covered damage was identified to the pool enclosure screens, screen doors, and wooden fence; however, the total damage did not exceed the $3,072 hurricane deductible. State Farm’s coverage determination was based on a thorough inspection, discussions with Complainants, and a review of all available information. • Section 626.9541(1)(i)(3)(f), Florida Statutes. In order to prove a violation under this provision of the law, Complainants must show State Farm commits this action “with such frequency to indicate a general business practice.” State Farm specifically denies this allegation. Complainants’ CRN contains no allegations regarding the frequency with which State Farm engages in this practice. Additionally, the CRN fails to provide any detail as to how State Farm allegedly did not promptly provide a reasonable written explanation to the insured regarding the basis for the partial denial of this claim under the policy, in relation to the facts or applicable law. State Farm’s coverage decision letter, dated December 26, 2024, clearly outlines the relevant policy provisions that formed the basis for the claim denial. Furthermore, the CRN does not even reference any issues with the denial letter in the Facts Section; rather, it solely disputes the outcome of the investigation. This lack of specificity fails to meet the statutory requirements for a valid CRN. In sum, the CRN is replete with conclusory assertions unsupported by any meaningful factual basis. Contrary to the specificity explicitly required by section 624.155(3)(b)2., the facts do not specify any details about the claimed damage. Furthermore, there are no dates, timeframes, or any other specific details concerning State Farm’s investigation of the claim, or its communication with Complainants and their representatives throughout the claims handling process, to substantiate any recitation of the Florida law cited. Rather the few “facts” that are contained in the CRN comprise an incomplete and inaccurate recitation of what transpired after windstorm allegedly damaged Complainants’ property. Additionally, the CRN relies on vague and conclusory allegations, the bulk of which merely parrot language from sections 624.155(1)(b) and 626.9541(1)(i)(3) without providing any claim-specific factual basis in support of same. Moreover, the CRN does not comply with section 624.155(3)(b)3., which requires Complainants to name “any individual involved in the violation.” In the Notice Against section, Complainants list “Sean Canada, Kevin Mortley, Matthew Riofrio, Frank Barclay, and any other individual from, or agent of, State Farm Florida Insurance Company who was involved in the claim.” However, these individuals are never mentioned again. Furthermore, the CRN provides no detail or clarity whatsoever as to why—or how—the individuals listed in the CRN can simultaneously possess the most knowledge of the facts giving rise to the CRN’s allegations, and how or why all these individuals are together most responsible for these facts. The CRN does not distinguish whether some individuals are responsible for some violations and not others, or if all are cumulatively responsible for all allegations, much less does it give any explanation as to how the purported actions or omissions of these individuals amounted to a violation of Florida law. There is simply no allegation of wrongdoing tied to any of these people at State Farm named in this CRN. This lack of specificity with regard to who was involved in the other strong allegations does not give State Farm adequate notice and renders the CRN invalid, as State Farm cannot conduct a fair and reasonable investigation before the expiration of the 60 days for this CRN based on such overbroad allegations. The CRN fails to reference any specific policy violations. Instead, it cites Florida Statute § 627.444(2)(a) and case law from Westside EKG Assocs. Florida law requires a CRN to include specific details about the alleged bad faith conduct, including the policy provisions that were allegedly violated. Here, no policy language violation is identified. In the facts section, Complainants claim that "Insured breached the policy by failing to fully indemnify the Insured for the covered loss." However, they do not cite any specific policy provisions that were allegedly breached. The CRN is generic and lacks specificity regarding how State Farm allegedly violated the policy or how the allegations relate to the subject claim or statutory bad faith provisions. The CRN thereby fails to comply with the specificity requirements of section 624.155(3)(b), especially given the broad, sweeping, and vague nature of the CRN’s reference to certain alleged policy contents. This is prejudicial to State Farm. The CRN offers no basis and no policy provisions that might provide coverage for this claim, and none that might alter State Farm’s decision on this claim or warrant reconsideration. Indeed, Complainants’ assertion that State Farm breached the policy by failing to apply the concurrent clause doctrine expressly contradicts the policy, which contains an anti-concurrent cause clause. In accordance with the case cited by Complainants in the CRN, the policy’s plain language controls, and thus, State Farm cannot possibly have breached the insurance policy by failing to extend coverage where it was precluded from doing so by the policy itself. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016) (“Insurance contracts are construed in accordance with the plain language of the policy.”). Under Florida law, Complainants cannot prevail on a claim for extra-contractual damages without first establishing State Farm breached the insurance contract, yet they would force State Farm to essentially guess what policy provisions they believe were allegedly violated and why. An insurer cannot be forced to guess about these or any other matters. The CRN is therefore invalid. See Julien, 311 So. 3d 875 (holding broad references to policy language do not satisfy the specificity requirements of the civil remedy notice statute; such requirements are not mere technicalities). In addition, Complainants make improper and ambiguous demands which likewise invalidate the CRN. They demand State Farm “(1) Admit full coverage for the Insureds’ loss, and (2) Tender full benefits owed to the Insured under the insurance contract.” See CRN at 4. To be clear, State Farm acknowledges that a CRN is not required to state the dollar amount being demanded, but the CRN must provide the insurer with sufficient information and a reasonable basis from which the insurer can determine what amount is being demanded to cure the claim. Similarly, if a CRN does demand a dollar amount, it must do so with specificity and without ambiguity. This CRN does neither. Defects such as these, which create genuine doubt and ambiguity as to what Complainants are seeking to cure the CRN, render the CRN invalid. Furthermore, Florida law does not impose on an insurer the obligation to pay whatever the insured or claimant demands, such as the estimate discussed in the CRN. Rather, in a first-party matter such as this, an insurer is only required to pay the contractual amount still owed under the policy—if any. Thus, any demand that the insurer must purportedly pay inferred costs, a subjective amount Complainants seeks through his estimate, or any other type of extra-contractual damages renders the CRN a legal nullity. See Lane v. Westfield Ins. Co., 862 So. 2d 774, 779 (Fla. 5th DCA 2003). The purpose of the CRN is not to force the insurer to engage in a guessing game. Yet that is precisely what this CRN does by virtue of its lack of specificity and other defects. The deficiencies described above deprive State Farm of any meaningful notice and ability to respond. They also render any purported “cure” provisions illusory and render the CRN invalid. Defects such as these thwart the fundamental purpose of the CRN, which is to give the insurer the opportunity to cure the alleged violations within the 60-day statutory period. This CRN is contrary to the purpose and requirements of Florida law, including the notice and cure provisions of section 624.155, which are a necessary prerequisite to any future bad faith action against State Farm. See, e.g., Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000). An invalid CRN, such as this, cannot serve as a condition precedent to any action for alleged bad faith against State Farm under section 624.155 or otherwise under Florida law. As such, this CRN should not be permitted to serve as the legal precursor for a bad-faith lawsuit, or any other action against State Farm. Subject to and without waiving these denials and objections and any other available defenses, State Farm submits that it has not violated any applicable provision of Florida law in handling this claim, in any way related to this claim, or in any litigation related to this claim. FACTS OF CLAIM As noted above, this claim stems from alleged wind and hail damage to Complainants’ property that purportedly occurred on October 10, 2024 and reported to State Farm on October 18, 2024 by Complainants. Upon receiving notice of the loss, State Farm immediately acknowledged the claim in writing issuing its Homeowner’s Bill of Rights and Duties After Loss correspondence, advising Complainants of the claim process, obligations under the policy and rights. On November 4, 2024, Coastal Claims Services sent letter of representation and contract to State Farm. On November 11, 2024, State Farm sent an acknowledgment of the letter of representation to Coastal Claims Services. On December 2, 2024, State Farm inspected Complainants’ property with Public Adjuster, Carlos Puente from Coastal Claims Services present. State Farm’s inspection confirmed covered damage to the pool enclosure screens, screen doors, and wood fence from October 10, 2024. However, the total damage did not exceed the $3,072 hurricane deductible, so no payment was issued. In regards to the dwelling roof and exterior, no accidental direct physical loss was found—only wear, tear, and deterioration. On December 11, 2024, Complainants’ attorney, Krapf Legal submitted a letter of representation to State Farm requesting documents including but not limited to the Loss Run Statement. On December 12, 2024, State Farm sent an acknowledgment of the letter of representation to Complainants’ attorney. On December 26, 2024, State Farm issued its coverage determination correspondence explaining its coverage decision. Complainants and/or their representative were also provided a copy of the State Farm’s findings and estimate. Complainants were also provided with information about mediation offered through DFS in the event they disputed State Farm’s determination, and furthermore, was encouraged to provide any additional information they may have pertaining to the claim. On January 8, 2025, Complainants’ attorney submitted a sworn proof of loss for $51,802.52 with an estimate from Coastal Claims for the same amount attached and filed this CRN. On January 15, 2025, State Farm acknowledged Complainants’ Loss Run Statement request and advised their attorney to contact LexisNexis for further assistance. On January 18, 2025, State Farm sent a copy of the policy of record to Complainants’ counsel. On January 20, 2025, State Farm issued a denial of the sworn proof of loss statement, and stated that it was not submitted within the timeframe outlined in the policy. State Farm also stated that it could not agree with the claimed amount based on its inspection of Complainants’ property. On January 21, 2025, Complainants’ attorney filed a Notice of Intent to Litigate for $54,875.00. State Farm timely responded to the Notice of Intent on February 4, 2025, reaffirming its prior coverage decision on the claim. State Farm has at all times acted in good faith, promptly, fairly, honestly, and with due diligence in its handling, investigation, and/or determination of what is owed on the claim and in any related litigation. State Farm is ultimately bound by the terms of the policy—just as Complainants are. Pursuant to the insurance contract, State Farm has a duty to extend coverage for “accidental” losses that are covered by the policy, and no duty to extend coverage for losses that are not. Even so, State Farm remains willing to review and consider any additional information Complainants believe to be relevant to this matter. State Farm will evaluate any additional information or documentation it receives in good faith, like it has already done thus far. As the foregoing demonstrates and confirms, State Farm has at all times handled this claim in good faith and is continuing to handle it in good faith. These are intended as examples and are not exhaustive. State Farm objects to and denies the allegations of the CRN. The objections and denials herein are not necessarily exhaustive and this response shall not prevent State Farm from asserting any other appropriate objections, denials, and/or defenses related to this claim and/or CRN. Moreover, due to the objections and defects discussed herein, the Department should strike and/or reject the CRN as invalid. As a final matter, it should be emphasized that any policy issued by State Farm is governed by the policy’s terms, conditions, and exclusions together with any endorsements. This CRN response does not waive any such provisions of the policy. Furthermore, any action taken by or on behalf of State Farm or its authorized representative(s), whether in the past or future, to investigate the alleged loss, to adjust any claim or request for payment, or in any way related to or arising out of the subject claim or loss, shall not waive any of the terms, conditions, or any other provisions of the policy. Thank you for your time and attention in this matter. Please contact us if you have any questions or require additional information. Sincerely, /s/ Ashley L. Palmer Christopher M. DelBene, Esq. Ashley L. Palmer, Esq. cc: State Farm
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