Civil Remedy Notice of Insurer Violations
Login

Filing Number:     800477
Filing Accepted:  1/10/2025
         Print Filing
Complainant
Last/Business Name *  
MYRIAM JUMELLES AND NELSON JUMELLES   First Name  
Street Address * 2661 VILLAGIO BLVD.
City, State Zip * ST. CLOUD, FL 34772
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MYRIAM JUMELLES AND NELSON JUMELLES   First Name  
Policy # * 76581-93-26 Claim #* 7006802429-1
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM AMERICAN SECURITY INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
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 POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 76581-93-26 INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Myriam Jumelles and Nelson Jumelles (hereinafter “Insureds”) are homeowners insured with an all-risks policy issued by Truck Insurance Exchange (hereinafter “Carrier”). On or about November 2, 2023, Insureds’ home located at 2661 Villagio Blvd., St. Cloud, Florida 34772 sustained significant damage as a result of a water event. Specifically, Insured’s property sustained water damage due to a plumbing failure in the bathroom. The discharge of water caused damage to the Insured’s property, including but not limited to, the bathroom, and art storage room. The Loss is covered under Insured’s policy issued by Carrier. The Insured mitigated damages by contacting Eco-Pro Restorations SA LLC who performed mold testing on the subject property. All of the relevant documents were provided to Carrier. Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. 7006802429-1 to the loss. The Insureds have fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $98,485.73, which was a fair and reasonable assessment for the repair/replacement of damages. Eco-Pro Restorations SA LLC has an outstanding balance in the amount of $2,500.00 for their mold testing. Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier gave Insureds a lowball estimate that failed to encompass all covered damages. The carrier only offered to pay $4,817.79, a gross underpayment for all the damage associated with this claim. This has become a common business practice for Carrier. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insureds and with due regard for the Insureds’ interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insureds that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be 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. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insureds, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insureds’ claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of $98,485.73, and Eco-Pro Restorations SA LLC in the amount of $2,500.00, less applicable deductible and prior payments, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: Truck Insurance Exchange.
Comments
User Id Date Added Comment
cheryl.perez@farmersinsurance.com 02-19-2025 February 19, 2025 Via E-Mail Kuhn Raslavich PA 2110 W Platt St Tampa, FL 33606 Delivered by email to: clay@thekrfirm.com RE: Myriam Jumelles and Nelson Jumelles Claim No.: 7006802429-1 Dear Clayton Kuhn, This correspondence is Truck Insurance Exchange’s (“Truck”) response to the Civil Remedy Notice of Insurer Violation No. 800477 filed on behalf of Complainant Myriam Jumelles and Nelson Jumelles on January 10, 2025. Complainant alleges that Truck violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 7006802429-1 under an insurance policy issued by Truck to Complainant. Truck welcomes the opportunity to respond to the Notice’s allegations. The Notice fails to comply with the specific notice and information requirements set forth in Section 624.155, Florida Statutes, and Form DFS-10-363. Florida law requires strict compliance with the specific notice and information requirements of section 624.155, Florida Statutes. This notice is invalid for the following reasons related to the failure to include information required on Form DFS-10-363: • The notice does not provide the Complainant’s email address. This notice is also invalid due to the failure to include statutorily required information as follows: • The notice does not identify or narrow the person(s) representing the insurer who are most responsible for or who have knowledge of the facts giving rise to the allegations in Complainant's Notice. Please be advised the correct insuring entity for the claim handlers is Truck Insurance Exchange, not American Security Insurance Company. • The Complainant has failed to provide “specific policy language that is relevant to the violation, if any,” as required by section 624.155, Florida Statutes. Instead, the Complainant has essentially cited all of the language contained within the policy of insurance. Accordingly, Truck is without proper notice as to the specific violations the Complainant alleges were violated. On the merits, Truck avers it handled Complainant’s claim correctly, fairly, in good faith and with due regard for their interests under Complainant’s policy. A review of our records shows Trust Public Adjusters reported this loss on November 14, 2023, water damage to the Complainant’s property on November 2, 2023 from a supply line failure in the hall bathroom. Despite the nearly two weeks delay in reporting this loss, Truck conducted a prompt and thorough investigation into this claim. We immediately made multiple contact attempts to gather information and schedule the inspection. After two weeks, Truck finally received a return call and the inspection was scheduled. Truck’s claim representative completed the inspection as scheduled in the presence of the insured and public adjuster on November 30, 2023. The inspection revealed both covered and non-covered damage. We found covered water damage to the hall half bathroom, art storage area under the stairs and personal property. The toilet supply line failed from wear and tear and the repair is not covered by the policy. Damage to the paintings held for sale are considered business property and subject to the $2,500.00 policy aggregate limit. We reviewed the findings with the public adjuster and provided our estimate and partial denial letter of explanation for the covered repairs on November 30, 2023. On December 6, 2023 we received an estimate from Trust Public Adjusters. The estimate did not reflect the art business personal property policy limit of $2,500.00. We determined the estimate did not support the presence of additional covered damage to our insured’s property. As such, Truck responded and advised our position on coverage and the claim remains unchanged. On January 2, 2024 we issued a payment in the amount of $2,300.00 for the water mitigation services performed by Loss Restorations. The invoice was reviewed by a third-party vendor, Accuserve, and this amount was agreed upon with Loss Restorations. On January 10, 2024 we received a mold invoice from Eco-Pro Restorations unaccompanied by any supporting documentation. Truck requested a copy of the mold report and payment for the approved amount of $925.88 was issued January 19, 2024. The only facts that Complainant alleges to support their allegations that Truck violated Florida law and handled Complainant’s claim in bad faith is that Truck’s adjustment of the claim did not result in payment of Complainant’s exorbitant demand. Truck’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the conditions and coverage limits of the policy. In accordance with these terms, Truck properly adjusted this claim. Accordingly, contrary to Complainant’s apparent contention, Truck’s coverage determination was made in good faith. Truck denies any breach of any statutory or contractual duties in the handling of Complainant’s claim. The notice alleges Truck only offered to pay $4,817.79, however our records reflect a payment total of $8,043.67. The $2,500.00 deductible was applied to the excess loss for the paintings that exceeded the business personal property limit of $2,500.00. Since we have been advised that a lawsuit has been filed on this claim, our defense counsel will discuss the facts and the perceived issues with you further during the course of the litigation. At this time, our position on coverage and this claim remains unchanged. While this response is meant to be comprehensive, Truck’s response is based on the limited information provided in the Notice filed by Complainant. Also, this letter or any act or failure to act on the part of Truck or any agent or representative of Truck should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service, available to it by contract or at law as all such right and defenses are hereby specially reserved. We trust that this response addresses the allegations raised in the Notice. Please contact me if you have any questions or should you wish to discuss this matter further. Sincerely, Cheryl Perez, Company Employee Adjuster General Claims Adjuster (913) 274-0230 Truck Insurance Exchange
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