Civil Remedy Notice of Insurer Violations
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Filing Number:     800953
Filing Accepted:  1/14/2025
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Complainant
Last/Business Name *  
MOORE   First Name   MELVIN
Street Address * 554 SE 3RD STREET
City, State Zip * BELLE GLADE, FL 33430-40
Email Address * MELVINMOORE321@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MOORE   First Name   MELVIN
Policy # * FHP L163666 Claim #* CLM00599678
Attorney
Attorney is Applicable
Last Name* MELROSE First Name * DANIEL Initial P
Street Address* 1630 WEST HILLSBORO BLVD
City, State Zip* DEERFIELD BEACH , FL 33442
Email Address * MELROSE@GDINJURYLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AUTO CLUB INSURANCE COMPANY OF FLORIDA
NAIC Company Code 12813
 
Name of individual responsible for violation (if any):* SCOTT GOOD
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
* 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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

HOMEOWNERS FORM - 3 POLICY COVERAGES THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU. Part I - Property Coverages lf a cause of loss covered under WHAT LOSSES ARE COVERED~ COVERAGE A AND COVERAGE B results in direct damage to any covered building, we will pay the additional cost actually and necessarily incurred by you resulting from the enforcement of any ordinance or law applicable at the time of the loss: a. regulating the construction, use, or repair of the building; b. requiring the demolition, meaning the tearing down and removing the debris of the building. Our limit of liability under this endorsement shall not exceed 25% of the amount of the limit of liability stated on the declaration page for COVERAGE A - DWELLING for the additional cost actually and necessarily incurred by you resulting from the enforcement of any ordinance or law applicable at the time of the loss. Coverage A - Dwelling: This covers the dwelling, including structures attached to it, on the residence premises. Residence premises means the insured location shown on the declarations page. Section I Homeowners Coverages 5. Loss Settlement and Limit of Liability e. We will settle covered losses to buildings as follows: ... (2) If the loss is not subject to payment under e. (1) above, we will settle covered losses for the lower of: (a) the replacement cost of the damaged or destroyed part of the building less depreciation; (b) the limit of liability stated on the declarations page for COVERAGE A for loss to the dwelling, or for COVERAGE B for loss to other buildings. We shall pay any remaining amounts necessary to repair or replace the damaged or destroyed part of the building as work is performed and expenses are incurred. If a total loss of a covered building occurs, we shall pay the replacement cost coverage without reservation or holdback of any depreciation in value. Any amount we pay shall not exceed the amount of the limit of liability stated on the declarations page for COVERAGE A for loss to the dwelling, or for COVERAGE B for loss to other buildings.
 
* 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 September 29, 2022, the property located at 554 SE 3rd St., Belle Glade, FL 33430-4010, suffered direct and significant physical damage due to water intrusion caused by a peril-created opening in the roof resulting from Hurricane Ian. This peril-created opening caused extensive water damage to the structure and interior of the property, necessitating substantial repairs. The insured promptly provided notice of this loss and filed a claim with Auto Club Insurance Company of Florida ("Auto Club"), seeking payment for the damages. Upon investigation, Auto Club determined that the loss was a covered peril under the policy but concluded that the damages fell below the insured's deductible. This determination failed to adequately account for the full scope and extent of the damages sustained by the property. Despite evidence provided by the insured, including an itemized estimate and an expert report detailing damages totaling an Actual Cash Value of $87,102.66, Auto Club failed to conduct a thorough investigation of the property’s damaged areas. By doing so, Auto Club breached its contractual obligations under the policy by: Failing to properly and adequately inspect the property for all damaged areas; Failing to tender proper and full payment for the damages sustained under the policy; Breaching the provisions of Florida Statute § 627.7022 by not appropriately calculating the actual cash value (ACV) or addressing the full scope of repair costs. The insured has made a pre-suit settlement demand in the amount of $87,102.66 for the damages to the property, along with $4350.00 in costs. A detailed ACV repair estimate and expert report substantiating the claimed damages are attached to this Notice. Auto Club’s failure to tender full payment for this covered loss constitutes a breach of contract and demonstrates a failure to act fairly and in good faith towards its insured, as required by Florida Statute § 624.155(1)(b)(1). Moreover, Auto Club's actions, including its inadequate investigation, undervaluation of damages, and improper reliance on the deductible threshold, indicate violations of Florida Statute § 626.9541(1)(i)(3), including but not limited to: Failing to adopt and implement standards for the proper investigation of claims; Misrepresenting pertinent facts or insurance policy provisions related to the claim; Failing to promptly settle claims when liability was reasonably clear. The insured has provided Auto Club with every opportunity to resolve this claim amicably and avoid litigation. Despite this, Auto Club has failed to appropriately address the loss or resolve the dispute in good faith. The insured hereby demands full payment of the claimed damages, as detailed in the attached estimate and supporting documentation, and reserves all substantive rights and remedies available under the policy and applicable law.
Comments
User Id Date Added Comment
kmixon@gspalaw.com 02-06-2025 February 6, 2025 Via Electronic Filing Department of Financial Services Civil Remedy Notice Department 200 East Gaines Street Tallahassee, Florida 32399 RE: Insured: Melvin Moore Claim No.: CLM00599678 Policy No.: FHP1163666 Date of Loss: September 29, 2022 Our File No.: AAA.48598-AV CRN No.: 800953 Dear Sir or Madam: Auto Club Insurance Company of Florida (“Auto Club” or “Insurer”) is in receipt of the Civil Remedy Notice of Insurer Violation (“Notice”), submitted by Daniel P. Melrose, Esq. on behalf of the complainant, “Melvin Moore” (“Insured”). The Notice was marked accepted by the Department of Financial Services on January 14, 2025 and was assigned Filing Number 800953. The Notice relates to claim number CLM00599678, resulting from Hurricane Ian. (“Claim”). Initially, Auto Club asserts the Notice fails to comply with the requirements of Florida Statutes §624.155, in that it fails to set forth the specific policy language relevant to any alleged violation. Further, the Notice fails to include specific facts or circumstances to support the vague, conclusory allegations asserted in the Notice. In addition, the Notice fails to comply as it does not specify a cure as required by the statute. Notwithstanding the failure of the Notice to comply with Florida Statute §624.155, Auto Club does hereby respond to the allegations of the Notice so as to avoid any presumption that may be made by lack of response, notwithstanding the clear documented facts that are contrary to the unsupported allegations asserted in the Notice. Auto Club expressly denies the allegations asserted in the Notice – that may be referenced by statute or otherwise - to the extent it alleges lack of a timely response to the notice of claim, implementing proper standards in its inspections and investigation of the claim, that it did not diligently and properly respond to and evaluate the claim, or satisfy its contractual and indemnity obligations to the insured. The documented facts and communications in the claim clearly reveal that Auto Club responded timely, properly advised the Insured or their representatives of the information and access for inspections to allow Auto Club to timely obtain all relevant information to properly and fully evaluate the claim and its obligations under the insurance policy. Further, Auto Club ultimately rendered its coverage decision and informed the Insured and their representatives of same within the time afforded under the Policy and Florida Statutes. As to the alleged factual basis asserted for the submission of the Notice, Auto Club responds as follows: Claim Denial: This allegation is without basis and therefore denied. Auto Club investigated and evaluated this matter prior to issuing its coverage decision with respect to the alleged damage. The Notice alleges that Auto Club has wrongfully denied the claim is false as the investigation revealed that certain damages did not qualify for coverage. ALLEGED STATUTORY VIOLATIONS: 624.155(1)(b)(1): This allegation is denied. Auto Club acted in good faith at all time and acted in accordance with the policy of insurance and the Florida Statutes. There exist no facts or circumstances to support this allegation in the Notice. 626.9541(1)(i)(3)(a): This allegation is denied. Auto Club has adopted and implemented standards for the proper investigation of claims. Auto Club acted in good faith at all times and acted in accordance with Florida Statutes. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the Notice. 626.9541(1)(i)(3)(b): This allegation is denied. Auto Club has not misrepresented any facts or policy provisions in any form and specifically not in regard to coverages at issue. The policy of insurance clearly outlines coverages and exclusions and Auto Club has applied these provisions. Auto Club acted in good faith at all times and acted in accordance with the policy of insurance and Florida Statutes. There exist no facts or circumstances to support this allegation in the Notice. 626.9541(1)(i)(3)(c): This allegation is denied. Auto Club has acknowledged and acted promptly upon all communications in this claim. All communications were promptly responded to and acknowledged at all times. There exist no facts or circumstances to support this allegation in the Notice. 626.9541(1)(i)(3)(d): This allegation is denied. Auto Club has acknowledged and acted promptly to conduct the necessary inspections of the property. There exist no facts or circumstances to support this allegation in the Notice. 626.9541(1)(i)(4) This allegation is denied. There is no basis for same as Auto Club satisfied its obligation under the law and the Policy. There exist no facts or circumstances to support this allegation in the Notice. The Complainant never asserts what Auto Club must do to ‘cure’ the subject conduct referenced in the Notice. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, “Section §624.155 does not impose on the insurer the obligation to pay whatever the insured demands….Section §624.155(2)(d) would have no effect or purpose under such an interpretation.” Talat, 753 So.2d at 1282 citing Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co.. 952 F.Supp. 773,777-778 (M.D. Fla. 1996). CONCLUSION/SUMMATION: The Notice fails to comply with the statutory requirements of Florida Statutes §624.155. Auto Club\ has nevertheless fully responded herein to the conclusory allegations asserted in the Notice. Auto Club has diligently and reasonably responded in the claim in an effort to bring the claim to an amicable resolution in accordance with the information provided in the claim, the inspection, and the terms of the insurance contract. It has at all times acted fairly in the administration of the claim, in compliance with the terms of the insurance policy and Florida law. Auto Club has attempted to fully and adequately respond to each of the Complainant’s allegations in the Notice filed with the Department. Should the Department have any questions or further inquiry with respect to this matter, please contact the undersigned. Very truly yours, GROELLE & SALMON, P.A. /s/ Nestor Marante Nestor A. Marante For the Firm
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