Civil Remedy Notice of Insurer Violations
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Filing Number:     800732
Filing Accepted:  1/13/2025
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Complainant
Last/Business Name *  
GONZALEZ- MARTINEZ; GONDIN-HERANDEZ   First Name   JOSE; LYAN
Street Address * 4155 SW 186TH WAY
City, State Zip * MIRAMAR, FL 33029-27
Email Address * JLISANDROGM@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GONZALEZ- MARTINEZ; GONDIN-HERANDEZ   First Name   JOSE; LYAN
Policy # * 79C4A1992 Claim #* 59-53L2-36K
Attorney
Attorney is Applicable
Last Name* BRAZ First Name * TAMARA Initial
Street Address* 8865 COMMODITY CIR. STE. 12
City, State Zip* ORLANDO , FL 32819
Email Address * TBRAZ@THELAWGICALFIRM.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):* ? GINA RODRIGUEZ, FIELD ADJUSTER ON BEHALF OF STATE FARM INSURANCE COMPANY;
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Other : Improper Investigation
* Statutory provision(s) which the insurer allegedly violated.
 
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of 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.

FORM: HW-2159 SECTION I – PROPERTY COVERAGES *** COVERAGE A – DWELLING 1. Dwelling. We cover the dwelling and materials and supplies located on or adjacent to the residence premises for use in the construction, alteration, or repair of the dwelling or other structures on the residence premises. *** HW-2159 *** SECTION I – LOSSES INSURED *** COVERAGE A – DWELLING We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded[…] ***
 
* 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 July 23, 2023, Jose Gonzalez- Martinez and Lyan Gondin-Herandez (Complainant(s)) suffered a loss to their Property, located at the address listed above due to water damage. After discovering the damage, Complainant(s) promptly reported the loss to State Farm Florida Insurance Company (“Insurer”) on or about July 25, 2023. Throughout the Insurer’s investigation, Complainant(s) have fully cooperated with the Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant(s) custody, possession and control. The Insurer, however, has failed to fulfill its duties under the Policy and Florida law by not conducting a fair and proper investigation of the claim. After discovering the damages to the property, the Complainant retained Luis Alonso, an independent plumber to mitigate the damage. On or about July 25, 2023, the Insurer sent a claim acknowledgement letter as well as a Homeowner Bill Of Rights letter. On or about July 27, 2023, the Field Adjuster assigned to the claim, Gina Rodriguez inspected the property and took photographs. The Field Adjuster, Gina Rodriguez, conducted a courtesy inspection of the property, relying solely on photographs taken with her iPhone and failing to utilize any professional tools or methods to assess the damages properly. Despite visible water damage, mold, and clear indications of prolonged moisture exposure, the Field Adjuster failed to conduct moisture readings or recommend further investigations by an expert. The assessment was limited to superficial visual observations and cursory notes, with no evaluations of plumping conditions or collection of data to substantiate Ms. Rodriguez’s conclusions. Such deficient investigative practices grossly fail to adhere to the standards required by Fla. Stat. 626.9541(1)(i)(3)(a), which mandates the adoption and implementation of proper standards for the investigation of claims. The Field Adjuster’s qualifications were equally inadequate to assess causation. With only a Florida 6-20 license, she lacked the training or expertise necessary to determine the origin of the water damage. This license permits an adjuster only to assess damage amounts and settle claims, not to evaluate the technical causation of property damage. Despite her lack of expertise, the Insurer relied exclusively on her unsupported opinion to conclude that the damages were due to “seepage or leakage of water that occurred or developed over a period of time,” and thus not covered under the policy. Moreover, the Insurer did not attempt to corroborate the Field Adjuster’s findings with any additional investigation or by retaining a qualified expert. The Insurer failed to even consult the plumber-who initially repaired the property or to conduct the Insurer own thorough analysis to verify the causation of the damages. Instead, the Insurer hastily issued a coverage determination letter on or about July 28, 2023, dated July 27, 2023, denying the claim. The coverage determination letter stated: “It was determined that there was no covered accidental direct physical loss to the insured property. The damage to the property was as a result of seepage or leakage of water that occurred or developed over a period of time which is not covered under the policy.” This statement highlights the Insurer’s failure to investigate the claim in a reasonable manner and even providing a reasonable explanation to the denial of the claim as required by Fla. Stat. 626.9541(1)(i)(3)(f). The Insurer failed to provide any explanation regarding the cause of the damages or even a brief clarification on the matter. The Insurer’s denial was based solely on an unsupported conclusion by the Field Adjuster, who lacked the qualifications to assess causation and did not conduct an investigation that met even the most basic standards of thoroughness. On or about September 11, 2023, the Complainant retained The Lawgical for legal representation. On or about September 13, 2023, the Complainant retained Property Claim Consultants to conduct an independent investigation of the property and prepare a comprehensive estimate of the damages. An inspection of the property was conducted later that day, during which photographs were taken. On or about September 14, 2023, the Insurer sent a letter acknowledging Lawgical’s representation. On or about September 25, 2023, Property Claim Consultants produced an estimate assessing the damages at $248,326.51. This estimate, along with photographs taken during the inspection, was promptly sent to the Insurer. Merely a day later, on or about September 26, 2023, the Insurer responded by email acknowledging receipt of the estimate and photographs. However, instead of addressing the newly provided documentation or engaging in any meaningful investigation, the Insurer denied the claim outright. The email included nothing more than a copy of the initial denial letter, dated July 27, 2023, without any explanation or analysis of the new evidence submitted. The Insurer’s continued denial of the claim places it in clear violation of Fla. Stat. 626.9541(1)(i)(3)(d). Despite being presented with crucial information that should have prompted a reconsideration of the Insurer’s decision, the Insurer failed to provide any explanation as to why the claim remains denied. To date, the Insurer has made no effort to initiate any additional investigation, whether by retaining an expert or conducting a subsequent inspection, to rectify its initial improper assessment. Instead, the Insurer continues to rely solely on its flawed and inadequate initial investigation, leaving the issues unaddressed and unresolved. Overall, it is clear that the Insurer wholly failed to investigate causation, having only sent adjusters who are only qualified to document the condition of the Property, and assign repair values. Based on the events described above, it is clear that Insurer conducted an improper and haste investigation to intentionally minimize its liability, contrary to the policy and Florida law’s requirements. Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue to deny recovery to the Insureds. These tactics are believed to be the general business practices of this Insurer. Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $243,326.51, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy. PLEASE GOVERN YOURSELF ACCORDINGLY.
Comments
User Id Date Added Comment
mabisror@defenselaw.org 07-09-2025 Via Email tbraz@thelawgicalfirm.com Tamara Braz, Esquire The Lawgical Firm 8865 Commodity Circle Suite 12 Orlando, FL 32819 RE: CIVIL REMEDY NOTICE OF INSURER VIOLATIONS Complainants : Jose Gonzalez-Martinez & Lyan Gondin-Hernandez Insureds : Jose Gonzalez-Martinez & Lyan Gondin-Hernandez Insurer : State Farm Florida Insurance Company Claim No. : 59-53L2-36K DFS File No. : 800732 Filing Date : January 13, 2025 Dear Ms. Braz: As you may recall, I represent State Farm Florida Insurance Company. Please accept this letter as State Farm Florida Insurance Company's amended response to the referenced Civil Remedy Notice of Insurer Violations, filed with the Florida Department of Financial Services on January 13, 2025, on behalf of our policyholders, Jose Gonzalez-Martinez & Lyan Gondin-Hernandez. This amendment is to confirm that the parties have reached an amicable resolution of the matter. State Farm Florida Insurance Company (hereinafter referred to as “State Farm”) has at all times performed its obligations under the policy of insurance in a prompt and diligent manner with due regard for the interests of its policyholders, Jose Gonzalez-Martinez & Lyan Gondin-Hernandez. State Farm categorically denies any violation of §624.155, Fla.Stat. §626.9541, Fla. Stat., as well as other Florida Statutes and sections of the Florida Administrative Code and alleged in the Notice of Insurer Violations or otherwise. In response, State Farm states that it timely performed its investigation of the claim with due regards for the interests of the insureds. A civil remedy notice must be “specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days.” See Valenti v. Unum Life Ins. Co. of Am., 2006 WL 1627276 (M.D. Fla. June 6, 2006); see also Talat Enterprises, Inc. v. Aetna Cas. & Surety Ins. Co., 753 So. 2d 1278 (Fla. 2000), see also, Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021) and Fla. Stat. §624.155. Here, the Notice is insufficient on its face and does not comply with Florida law as it does not provide sufficient factual details as to the alleged violations and provides no specific “cure” as the “amounts” demanded are not quantified. Rather, the Notice merely makes conclusory and unsupported allegations of wrongdoing, all which State Farm denies. To prevail on a claim under the subsections of §626.9541(1)(i), a complainant must establish that the insurer committed the alleged unfair act(s) “with such frequency as to indicate a general business practice.” §626.9541(1)(i)(3), Florida Statutes (emphasis added). Although Florida law does not define “general business practice”, case law is clear that same means more than “acting in the proscribed manner in the complainant’s own claim.” Shannon R. Ginn Construction Co. v. Reliance Ins. Co., 51 F. Supp.2d 1347, 1353 (S.D.Fla. 1999). As such, the Complainants/Insureds’ accusations regarding State Farm’s handling of this claim would be irrelevant to a claim for unfair settlement practices, and insufficient proof of same. Despite this fact, however, State Farm denies any violation of §626.9541. State Farm denies any violation of §626.9541(1)(i)(3)(a),(d) and (f). In fact, subsection (f) has no bearing on the issues of this claim. Rather, State Farm acted in an honest fashion in conducting a reasonable investigation of the subject claim, based upon the available information, as described below. Without waiving its arguments that the Civil Remedy Notice is deficient and lacks legal sufficiency, State Farm believes the facts of this claim do not support the filing of a Civil Remedy Notice. The referenced matter involves the insureds’ claim that their home, located at 4155 SW 186th Way, Miramar, FL 33029-2767, sustained water damage from an alleged plumbing leak that occurred on July 23, 2023. The claim was reported by Jose Gonzalez-Martinez on July 25, 2023 where Mr. Gonzalez-Martinez advised that he had seen small amounts of water in the bathroom vanity that has worsened with time. They did not think it was an issue until the floors in the bathroom appeared to have water under the floors. They called a plumber who opened the wall and found water in the wall behind the vanity. State Farm continued its investigation of the claim which included an inspection of the insured home by State Farm Claims Specialist Gina Rodriguez as set forth in the Civil Remedy Notice. Ms. Rodriguez inspected the claimed damages on behalf of State Farm. During the inspection, the insureds said they first noticed water on the floor in the hall bathroom about 3 months prior and that the conditions worsened. The insureds further advised that the plumber cut a hole in the wall that allowed water to pour out of the wall. Ms. Rodriguez also found other water damage in the kitchen and the bar. She also found mold in the cabinets and bar. The baseboards throughout the living areas, bedrooms and closets are pulling away from the walls and some had dark stains. The window frames on the outside also had black staining. These conditions were all consistent with long term water intrusion. She noted the sliders appear to be leaking from the top and there was an accumulation of water on the bottom at each end that had become green and moldy. Ms. Rodriguez also noted a crack in the foundation on the outside of the home near the affected hall bathroom. The insured advised that when he stepped on the door sill that leads to the outside from the hall bath, he noticed water comes up from the bottom. She also noticed wood rot on the door frames. Based on State Farm’s investigation of the claim, State Farm advised the insured, in writing, that the claim was denied, and the appropriate policy provisions were included in the correspondence. Essentially, State Farm advised that there was no accidental direct physical loss to the insured property. Rather, the damage to the property is the result of seepage or leakage of water that occurred or developed over a period of time. By separate correspondence, the insureds were also advised of their right to participate in mediation through the Department of Financial Services. Thereafter, the insureds submitted an estimate of damages to State Farm along with a Sworn Statement in Proof of Loss. In response, State Farm advised the Sworn Statement in Proof of Loss was rejected as it was not submitted in accordance with the policy conditions and that State Farm stands by its coverage determination. Your office filed a Notice of Intent to Initiate Litigation on behalf of the insureds, Jose Gonzalez-Martinez & Lyan Gondin-Hernandez. State Farm responded to the Notice of Intent stating that it stands by the claim denial. Following State Farm’s response to the Notice of Intent, a lawsuit has been served on State Farm and experts have been retained who have further inspected the property. Since then, the parties have amicably resolved all the issues pertaining to the allegations in the lawsuit which State Farm continues to deny and the lawsuit has been dismissed with prejudice. Without waiving State Farm’s arguments that the subject Civil Remedy Notice is legally insufficient and non-compliant with Florida law, the response provided herein shows that State Farm has performed its obligations to Jose Gonzalez-Martinez & Lyan Gondin-Hernandez in a fair and honest manner with due regard for their interests. I trust that the foregoing adequately addresses any concerns that you may have regarding this matter. Please do not hesitate to contact me if you require more information. Very truly yours, MASSEL J. ABISROR cc: State Farm
mabisror@defenselaw.org 02-26-2025 tbraz@thelawgicalfirm.com Tamara Braz, Esquire The Lawgical Firm 8865 Commodity Circle Suite 12 Orlando, FL 32819 RE: CIVIL REMEDY NOTICE OF INSURER VIOLATIONS Complainants : Jose Gonzalez-Martinez & Lyan Gondin-Hernandez Insureds : Jose Gonzalez-Martinez & Lyan Gondin-Hernandez Insurer : State Farm Florida Insurance Company Claim No. : 59-53L2-36K DFS File No. : 800732 Filing Date : January 13, 2025 Dear Ms. Braz: I represent State Farm Florida Insurance Company. Please accept this letter as State Farm Florida Insurance Company's response to the referenced Civil Remedy Notice of Insurer Violations, filed with the Florida Department of Financial Services on January 13, 2025, on behalf of our policyholders, Jose Gonzalez-Martinez & Lyan Gondin-Hernandez. State Farm Florida Insurance Company (hereinafter referred to as “State Farm”) has at all times performed its obligations under the policy of insurance in a prompt and diligent manner with due regard for the interests of its policyholders, Jose Gonzalez-Martinez & Lyan Gondin-Hernandez. State Farm categorically denies any violation of §624.155, Fla.Stat. §626.9541, Fla. Stat., as well as other Florida Statutes and sections of the Florida Administrative Code and alleged in the Notice of Insurer Violations or otherwise. In response, State Farm states that it timely performed its investigation of the claim with due regards for the interests of the insureds. A civil remedy notice must be “specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days.” See Valenti v. Unum Life Ins. Co. of Am., 2006 WL 1627276 (M.D. Fla. June 6, 2006); see also Talat Enterprises, Inc. v. Aetna Cas. & Surety Ins. Co., 753 So. 2d 1278 (Fla. 2000), see also, Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021) and Fla. Stat. §624.155. Here, the Notice is insufficient on its face and does not comply with Florida law as it does not provide sufficient factual details as to the alleged violations and provides no specific “cure” as the “amounts” demanded are not quantified. Rather, the Notice merely makes conclusory and unsupported allegations of wrongdoing, all which State Farm denies. To prevail on a claim under the subsections of §626.9541(1)(i), a complainant must establish that the insurer committed the alleged unfair act(s) “with such frequency as to indicate a general business practice.” §626.9541(1)(i)(3), Florida Statutes (emphasis added). Although Florida law does not define “general business practice”, case law is clear that same means more than “acting in the proscribed manner in the complainant’s own claim.” Shannon R. Ginn Construction Co. v. Reliance Ins. Co., 51 F. Supp.2d 1347, 1353 (S.D.Fla. 1999). As such, the Complainants/Insureds’ accusations regarding State Farm’s handling of this claim would be irrelevant to a claim for unfair settlement practices, and insufficient proof of same. Despite this fact, however, State Farm denies any violation of §626.9541. State Farm denies any violation of §626.9541(1)(i)(3)(a),(d) and (f). In fact, subsection (f) has no bearing on the issues of this claim. Rather, State Farm acted in an honest fashion in conducting a reasonable investigation of the subject claim, based upon the available information, as described below. Without waiving its arguments that the Civil Remedy Notice is deficient and lacks legal sufficiency, State Farm believes the facts of this claim do not support the filing of a Civil Remedy Notice. The referenced matter involves the insureds’ claim that their home, located at 4155 SW 186th Way, Miramar, FL 33029-2767, sustained water damage from an alleged plumbing leak that occurred on July 23, 2023. The claim was reported by Jose Gonzalez-Martinez on July 25, 2023 where Mr. Gonzalez-Martinez advised that he had seen small amounts of water in the bathroom vanity that has worsened with time. They did not think it was an issue until the floors in the bathroom appeared to have water under the floors. They called a plumber who opened the wall and found water in the wall behind the vanity. State Farm continued its investigation of the claim which included an inspection of the insured home by State Farm Claims Specialist Gina Rodriguez as set forth in the Civil Remedy Notice. Ms. Rodriguez inspected the claimed damages on behalf of State Farm. During the inspection, the insureds said they first noticed water on the floor in the hall bathroom about 3 months prior and that the conditions worsened. The insureds further advised that the plumber cut a hole in the wall that allowed water to pour out of the wall. Ms. Rodriguez also found other water damage in the kitchen and the bar. She also found mold in the cabinets and bar. The baseboards throughout the living areas, bedrooms and closets are pulling away from the walls and some had dark stains. The window frames on the outside also had black staining. These conditions were all consistent with long term water intrusion. She noted the sliders appear to be leaking from the top and there was an accumulation of water on the bottom at each end that had become green and moldy. Ms. Rodriguez also noted a crack in the foundation on the outside of the home near the affected hall bathroom. The insured advised that when he stepped on the door sill that leads to the outside from the hall bath, he noticed water comes up from the bottom. She also noticed wood rot on the door frames. Based on State Farm’s investigation of the claim, State Farm advised the insured, in writing, that the claim was denied, and the appropriate policy provisions were included in the correspondence. Essentially, State Farm advised that there was no accidental direct physical loss to the insured property. Rather, the damage to the property is the result of seepage or leakage of water that occurred or developed over a period of time. By separate correspondence, the insureds were also advised of their right to participate in mediation through the Department of Financial Services. Thereafter, the insureds submitted an estimate of damages to State Farm along with a Sworn Statement in Proof of Loss. In response, State Farm advised the Sworn Statement in Proof of Loss was rejected as it was not submitted in accordance with the policy conditions and that State Farm stands by its coverage determination. Your office filed a Notice of Intent to Initiate Litigation on behalf of the insureds, Jose Gonzalez-Martinez & Lyan Gondin-Hernandez. State Farm responded to the Notice of Intent stating that it stands by the claim denial. Since then, a lawsuit has been served on State Farm and experts have been retained who have further inspected the property. No other information has been provided to State Farm to change its position thus far. Without waiving State Farm’s arguments that the subject Civil Remedy Notice is legally insufficient and non-compliant with Florida law, the response provided herein shows that State Farm has performed its obligations to Jose Gonzalez-Martinez & Lyan Gondin-Hernandez in a fair and honest manner with due regard for their interests. I trust that the foregoing adequately addresses any concerns that you may have regarding this matter. Please do not hesitate to contact me if you require more information. Very truly yours, MASSEL J. ABISROR 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.

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DFS-10-363
Rev. 10/14/2008