Civil Remedy Notice of Insurer Violations
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Filing Number:     800752
Filing Accepted:  1/13/2025
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Complainant
Last/Business Name *  
ALI   First Name   SHAWN
Street Address * 411 SOUTHWEST CRABAPPLE COVE
City, State Zip * PORT SAINT LUCIE, FL 34986
Email Address * SDC@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ALI   First Name   SHAWN
Policy # * 0821602963 Claim #* 01000108933
Attorney
Attorney is Applicable
Last Name* CHOKSHI First Name * SAURIN Initial
Street Address* 800 EAST BROWARD BOULEVARD, SUITE 510
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * SDC@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FIRST PROTECTIVE INSURANCE COMPANY
NAIC Company Code 10897
 
Name of individual responsible for violation (if any):* CLAIMS ADJUSTER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Delay
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.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss Settlement Provision Loss Payment Provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Shawn Ali (the "Insured") purchased an insurance policy ("Policy") from First Protective Insurance Company DBA Frontline Insurance ("Frontline"), with effective coverage on the date of the loss, on or about January 5, 2024, and policy number 0821602963 to insure his home located at 411 Southwest Crabapple Cove, Port St. Lucie, FL 34986 (the "Property"). On or about January 5, 2024, the aforementioned Property suffered severe damage as the result of a water leak, which caused damages to the Property, including but not limited to the interior and exterior of the property. The Insured promptly reported their claim to Frontline. Frontline acknowledged receipt of the claim by generating claim number 01000108933. The Insured retained Five Star Claims Adjusting (“Five Star”) to act as their public adjuster, to assist in the evaluation and inspection of damage to the property. Five Star investigated the property and generated an estimate for the damages in the amount of $160,042.79. The Insureds also hired Family First Restoration (Family First) to assist in remediating the damaged suffered. Five Star immediately sent their estimate to Frontline along with Family First’s invoices for remediation work. As required, Frontline went to inspect the property, but Frontline failed to issue any payment to the Insured. Frontline’s delay in making a coverage decision, and failure to participate in the settlement process in good faith has resulted in further damages to the Insured by preventing them from returning their Property to its pre-loss condition. It is clear that Frontline has been delaying making a coverage decision that broadly ignored the damage sustained to the Property, and despite the fact that the Insured actively provided all proofs of claim needed to have their claim evaluated fairly. As a direct consequence of Frontline’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insured and their family are continuing to sustain considerable hardship. Upon information and belief, Frontline, as part of its general business practice, delays making coverage decisions for its policyholders. Frontline stalls and intentionally delays the claim, changing adjusters and attorneys, and requesting numerous Examinations Under Oath and unrelated documents from the insured and their representatives. Frontline does this in a calculated and systematic scheme that begins with requesting the Examinations Under Oath of the insured, resident relatives, and the insured’s representatives, all under the false pretense that Frontline is “investigating” the claim. Frontline has violated Florida Statute § 624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. Frontline has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this claim. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insured has been treated in this manner by their insurance company after sustaining an obviously covered loss, submitting to every demand of Frontline, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. Frontline violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by making material misrepresentations to the Insured for the purpose of delaying making a coverage decision, and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. Frontline was informed multiple times of the facts of this loss and damages sustained by the Insured. The Examination Under Oath of the insured was completed on June 21, 2024, and the Examination Under Oath of the insured’s father, who was residing at the Property on the date of loss, was completed on August 29, 2024. While Frontline was made aware of all relevant information for the purpose of obtaining the money contractually owed to the Insured under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, Frontline gathered and accepted that information from the Examinations Under Oath, and has used it to play the delay game with the Insured, knowing all too well the additional damage and hardship that was being placed on the Insured by its actions. Frontline then requested the Examination Under Oath of the insured’s public adjuster, which was scheduled for the day of November 7, 2024, but was only partially completed. Frontline then rescheduled the continuation of the Examination Under Oath of the insured’s public adjuster for January 26, 2025. However, Frontline then delayed once more, and rescheduled the Examination Under Oath for the insured’s public adjuster to March 4, 2025, which was the first date of availability for Frontline’s attorney. Frontline violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper and timely investigation in this case. Frontline and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insured. In addition, after being placed on notice as to the blatant delay of the Insured’s claim, Frontline has yet to rectify their actions and do right by the Insured by paying the money he is contractually owed. Frontline violated § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon the communications with respect to the claim. Th this date, there still has yet to be a coverage decision made by Frontline, despite Frontline being presented with all relevant information and documents related to this claim. Frontline violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insured and his representatives of any additional information necessary for processing the claim. The Insured has more than complied with each and every request and there has still been no action/coverage decision by Frontline. In the event Frontline is still in need of additional information, they have failed to promptly notify the Insured in a timely manner. This pattern of behavior is perpetuated by Frontline and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insured throughout the insurance claim process. Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from Frontline approaching the investigation and settlement in a manner prejudicial to the Insured, failing to allow a fair settlement with the Insured, and acting with due diligence in achieving a proper coverage decision and disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insured were not afforded the professional duties entrusted on Frontline by the public. To date, Frontline has failed to adequately compensate the Insured for the damage that occurred on January 5, 2024. As a direct result of Frontline’s delay, the Insured were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that Frontline knowingly and intentionally are delaying the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured and their family is a direct result of Frontline’s reckless delay of the claim process. The Insured are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insured timely filed their claim and fulfilled all of their post-loss obligations. All requested information and documentation has been turned over to Frontline and their representatives promptly by the Insured. However, Frontline failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insured how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of their bargain after they satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Upon information and belief, the aforementioned actions complained of, among others, were made by Frontline so often as to constitute a general business practice, evidencing a motive to enhance Frontline’s profits, and designed to cause a detrimental effect to its policy holders. Frontline was aware that the Insured’s damages were covered and took advantage of its Insured in an attempt to force them into an irreparable disadvantaged position, which they hope will force the Insured to settle for less coverage than they are contractually entitled to under the policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Frontline fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Frontline must: (1) Immediately tender all insurance proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss; (3) Although the Insured have made a demand herein and have previously provided Frontline with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insured are still willing to consider and to potentially accept any reasonable counter-offer made by Frontline. Therefore, if Frontline is not in agreement with the Insured’s reasonable demand for payment of their rightfully-owed insurance benefits being submitted at this time, the Insured hereby requests that Frontline now make a reasonable counter-offer before the expiration of the cure period.
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 03-14-2025 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainant: Shawn Ali Policyholder: Shawn Ali Filer: Saurin Chokshi, Esq. Claim #: 01000108933 Policy #: 0821602963 CRN filing No.: 800752 CRN filing date: 1/13/2025 To whom it may concern at The Department of Financial Services: We write on behalf of First Protective Insurance Company, (hereafter “First Protective”), to respond to the Civil Remedy Notice of Insurer Violations submitted to the Department of Financial Services, (hereafter “DFS”), by Saurin Chokshi, Esq. on behalf of Shawn Ali, (hereafter “the Complainant”). The DFS accepted the Civil Remedy Notice for Filing 800752 on January 13, 2025. While the Civil Remedy Notice has since been withdrawn by the Complainant, we file this response in good faith. After reviewing the CRN, First Protective conducted a thorough review of its handling of the Complainant’s claim. First Protective denies that it has violated any of the statutes as alleged in the CRN. At all times, First Protective acted in good faith, fairly and honestly toward the Complainant and with due regard for its interests. First Protective also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information such as facts and circumstances to allow First Protective to correct the alleged violations. The Complainant alleges multiple violations of various statutory provisions in the CRN. Specifically, the Complainant allege violations of: 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. First Protective denies the allegation that it violated the above referenced statute. 624.155(1)(b)(3): Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. First Protective denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. First Protective denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. First Protective denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon written request of the insured within 30 days after proof-of-loss statements have been completed. First Protective denies the allegation that it violated the above referenced statute. 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 and applicable law, for denial of a claim or for the offer of a compromise settlement. First Protective denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(g): Failing to promptly notify the Insured of any additional information necessary for the processing of a claim. First Protective denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. First Protective denies the allegation that it violated the above referenced statute. First Protective specifically denies each and every one of the Complainant’s allegations that First Protective violated the above referenced statutes. In addition to the allegations specifically denied above, First Protective generally denies all allegations presented in this Civil Remedy Notice as First Protective has not violated any statute or rule. CRN MUST BE DISMISSED The Civil Remedy Notice must be dismissed first and foremost because the Complainant failed to allege any actual facts in support of the specific statutory allegations. Next, the Civil Remedy Notice requires that the Complainant “pursuant to section 624.155, F.S. please indicate all statutory provisions alleged to have been violated.” The notice filed in this matter includes a laundry list of statutory provision that could be claimed against an insurance company, regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the Civil Remedy Notice fails to identify any specific statute with facts and circumstances, First Protective is unable to properly respond, and it should be rejected and returned. The Purported Notice is wholly devoid of any factual allegations relating to the amount of any claims, or any reference to communications and/or actions possibly giving rise to any alleged violation. See Rousso v. Liberty Surplus Ins. Corp., No. 10-cv-20554, 2010 WL 7367059, at *4 (S.D. Fla. Aug. 13, 2010) (“In this case, the Plaintiffs do not explain how or identify which claims or suits the Defendant responded to in a manner that was contrary to good faith, unfair, or dishonest. This vagueness continues in the Plaintiffs' claim that the Defendant failed to respond to repeated pleas for assistance.”). These glaring deficiencies fail to apprise First Protective of the nature of any purported violation and cannot satisfy the statutory standard of “pleading the facts and circumstances” giving rise to the violation with specificity. The Notice also fails to set forth the applicable policy language or the policy provisions that have been violated. The Notice merely includes a reference to the Loss Settlement Provision and Coverage A of the subject policy. The Purported Notice first identifies Section 624.155(1)(b)(1), Florida Statutes, which addresses an insurer’s refusal to attempt to settle in good faith. The CRN, however, does not specify when any settlement opportunity or proposal existed, the details of the settlement proposal, the nature of the underlying claim(s), or the circumstances supporting the conclusion that the unspecified refusal to settle was not in good faith. To the extent the CRN suggests that First Protective should tender payment due on the claim, the CRN fails to provide sufficient description of the facts and circumstances supporting this contention. As to Section 624.155(1)(b)(3), Florida Statutes, the CRN does not identify any facts to support that First Protective failed to promptly settle a claim under one portion of the policy in order to influence settlement under other portions of the policy. As to Section 626.9541(1)(i)(3)(a), Florida Statutes, the CRN does not describe any standards applicable to the investigation of the purported “claim” advanced by the Complainant, much less the facts and circumstances giving rise to the contention that First Protective failed to adopt or implement such standards. The CRN does not identify any facts to support that First Protective failed to adopt and implement standards for the proper investigation of claims. The general defects specified above again apply with particularity here because the CRN’s failure to describe the facts or circumstances of the claim precludes First Protective from evaluating what error, if any, allegedly occurred during the claim process. Complainant cannot possibly support the position that the claim was denied improperly because the CRN provides no description of the applicable policy provisions, the facts or circumstances of First Protective’s investigation, the disposition of the claim, or the facts and circumstances indicating First Protective’s investigation was in some way defective. The CRN merely contains conclusory allegations which lack any substance in the way of factual support. Regarding the alleged violation of Section 626.9541(1)(i)(3)(c), Florida Statutes, the CRN utterly fails to describe any facts or circumstances giving rise to the contention that First Protective failed to acknowledge and act promptly upon communications with respect to claim. First Protective has promptly and appropriately responded to all communications from the Claimants. As to Section 626.9541(1)(i)(3)(f), Florida Statutes, the CRN does not describe any standards applicable to the purported “claim” advanced by the Complainant, much less any facts and circumstances giving rise to the contention that First Protective failed to provide a reasonable explanation in writing to the Complainant, of the basis in the insurance policy, in relation to the facts or applicable law, for its coverage determination of the claim. Regarding Section 626.9541(1)(i)(3)(g), Florida Statutes, the CRN does not describe any instances where First Protective failed to promptly notify the insureds of any additional information necessary for the processing of the claim. Finally, as to Section 626.9541(1)(i)(3)(h), Florida Statutes, the CRN does not describe any standards applicable to the purported “claim” advanced by the Complainant, much less the facts and circumstances giving rise to the contention that First Protective failed to clearly explain the nature of the requested information and reasons why the information was necessary. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the Civil Remedy Notice itself only provides unsupported, incorrect and merely conclusory allegations with no basis in fact or circumstances. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit and First Protective denies each and every one. The “facts and circumstances” provided in the CRN purporting to give rise to First Protective’s violations are a mere collection of vague conclussory allegations nearly mirroring the statutory language. Additionally, the CRN fails to identify specific policy language relevant to an alleged violation. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). The Complainant failed to state specific policy language or provide the specific facts underlying the basis for policy language relevant to any alleged violation. Instead, the subject CRN vaguely refers to the Loss Settlement Provision and Coverage A of the Policy. The CRN’s vague, conclusory reference regarding the policy lacks even the minimal specificity required. The allegations set forth in the civil remedy notice are denied as they are mere conclusory allegations unsupported by facts, devoid of logic and intended soley to tarnish First Protective’s name and reputation. First Protective, at all times, acted fairly, honestly and in good faith in its dealings with the Complainant. First Protective did not engage in unfair settlement practices nor did First Protective fail to promptly settle the claim or attempt to settle the claim in order to influence settlement under a different portion of the policy. First Protective at no time misrepresented any pertinent facts or insurance policy provisions. First Protective conducted a reasonable and prudent investigation of the claim and acted upon all communications from the Complainant. Finally, First Protective promptly and appropriately communicated with the Complainant and provided explanations for the actions and decisions that were made. First Protective retained independent field adjusters and conducted and inspection of the subject property to investigate the Complainant’ claim. Thereafter, First Protective made a coverage decision. As it relates to the facts of the claim, First Protective first received notice of the Insured’s claim on January 30, 2024, for a loss that reportedly occurred on January 5, 2024. After First Protective first received notice of the alleged loss, it immediately assigned claim number 01000108933 (“Claim”) to the loss. First Protective promptly scheduled inspection as part of its investigation of the claim, with an Independent Adjuster who conducted the inspection on February 6, 2024. Frist Protective then hired a General Contractor to inspect the property that took place on January 30, 2025. After analysis of the subject policy and its factual investigation including examinations under oath of both the Insured and Public Adjuster, First Protective issued its coverage determination on or about February 14, 2025, providing coverage for the Insured’s claim pursuant to the terms and conditions of the subject policy. The correspondence was in writing and was promptly sent to the Insured. The coverage determination letter clearly outlines the basis for First Protective’s coverage determination based on policy provisions, limitations, and exclusions. Coverage was afforded pursuant to the factual investigation and analysis of the subject policy. The facts above demonstrate quite clearly that First Protective acted in good faith, First Protective acted fairly and honestly, acknowledged and acted promptly upon receipt of the claim, attempted to determine coverage for the claim pursuant to the terms of the policy, took reasonable steps to investigate the claim, communicated reasonably with the Complainant about the claim, and provided the Complainant with a reasonable explanation for each of its actions. Clearly, First Protective conducted a comprehensive investigation into the subject claim and rendered its coverage decision based on the terms and conditions of the subject policy. Additionally, the Civil Remedy Notice demands “cures” for the alleged defects, however, these demands are improper under Florida case law. In Talat Enter., Inc., v. Aetna Cas. and Sur. Co., 753 So.2d 1278, 1281 (Fla. 2000), the Supreme Court of Florida held that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due to our insureds. The Talat Court commented, It naturally follows that for there to be a “cure,” what had to be “cured” is the non-payment of the contractual amount due the insured. In the context of a first-party insurance claim, the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled. As a result, only the demanded “cures” relating to the payment for covered damages are proper and legal – the remaining “cures” are improper remedies and contrary to Florida law. In closing, First Protective first believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law, and regardless of the rejection, First Protective denies all allegations contained in the Civil Remedy Notice and submits that there are no violations. While this response is meant to be comprehensive, First Protective’s response above is based upon the limited information provided in the Civil Remedy Notice and the information we have to date. If the Complainant feels that we are not in possession of all the facts, please inform us immediately. Please note that First Protective’s response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of First Protective or any agent or representative of First Protective should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Regards, s/ Donald S. Lavigne Donald S. Lavigne, Esquire On behalf of First Protective Insurance Company Cc: SDC@WEKLAW.COM
sdc@weklaw.com 01-23-2025 This filing is hereby withdrawn pursuant to an agreement of the parties.
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