Civil Remedy Notice of Insurer Violations
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Filing Number:     801111
Filing Accepted:  1/15/2025
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Complainant
Last/Business Name *  
TIMOTHY A. LIGHT AND NORA M. LIGHT   First Name  
Street Address * 26724 CIGAR LN
City, State Zip * WESLEY CHAPEL, FL 33544
Email Address * NTLIGHT@VERIZON.NET
Complainant Type: * Insured
Insured
Last/Business Name*   TIMOTHY A. LIGHT AND NORA M. LIGHT   First Name  
Policy # * PFL452024-00 Claim #* CFL24605426
Attorney
Attorney is Applicable
Last Name* DAVIS First Name * JARED Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JDAVIS@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* KINADIA WILLIAMS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
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)(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.

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

The carrier was immediately put on notice of the insureds’ water damage claim. Subsequently, the insureds prepared a loss package in the amount of $70,318.01 needed to restore the property back to its pre-loss condition. Whereas, the carrier has failed to prudently inspect the insureds’ property, come to a fair coverage determination and promptly pay the claim. The carrier improperly determined that the loss was not covered under the policy and wrongfully denied the claim. In turn, the insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insureds. About seventy-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $70,318.01, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Erica De Jesus at (561)-892- 9874 if you have any questions or concerns. Sincerely, Jared Davis Attorney at Law
Comments
User Id Date Added Comment
bfrankel@gmail.com 02-20-2025 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of its Insured, Nora Light (“Insured”). In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. To be more specific, the CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information the department may require: (1) The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. (2) The facts and circumstances giving rise to the violation. (3) The name of any individual involved in the violation. (4) Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third-party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. (5) A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted property and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insured’s CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes.   1) On 10/11/2024, the Insured called to report water under the kitchen and living room flooring caused by Hurricane Milton, occurring on 10/9/2024. Per the Insured, she had removed some flooring and there was water under the kitchen cabinets. She further advised that there had been about 18 inches of rainfall, and she believed the water to be coming from cracks in the wall or pipes. 2) Shortly after, on 10/17/2024, PTI’s Field Adjuster inspected the home in order to determine the cause of loss and scope of damages. At the time of the inspection, the Insured, Nora Light, was present and advised that about a year and a half ago they had a plumbing leak in the bathroom which prompted them to begin doing some remodeling which included replacement of the flooring. Per the Insured, when they removed the flooring they noted water damage to the baseboards of the living room along the left elevation and had it resealed below grade. In support thereof, the Insured submitted an invoice dated 12/5/2022 from “MFM Construction” for excavating, sealing and waterproofing the exterior walls, and touch up paint. As for the instant claim, the Insured stated that she noticed a smell of mold or mildew coming from the area of the lazy susan in the kitchen and noticed water coming in along the left elevation wall, at the floor level, and that she noticed a puddle of water in front of the kitchen sink. Throughout the inspection, PTI’s Field Adjuster did not observe any wind or weather-related damage to the roof or dwelling. On the exterior left elevation, the Field Adjuster documented hairline cracks around the kitchen window, as well as prior patches to the hair line cracks. The reported water damage was observed as subterranean and not the result of an active leak and/or attributable to hurricane or weather related damage. 3) As a result of the investigation, on 11/6/2024, PTI issued its coverage determination letter advising that the loss is not covered by the policy and went on to cite the relevant policy language relating to mold, surface water and pre-existing damage. Nevertheless, the Insured was advised to provide any additional information which would require PTI to reassess its claims decision. 4) After the issuance of its coverage letter, PTI received a Letter of Representation from Kanner & Pintaluga (“Insured’s Attorney”), which was followed by a Notice of Intent to Initiation Litigation (“NOI” Notice No.: 225420) filed on 1/15/2025. The Notice attached an estimate prepared by Soleil Claims on behalf of the Insured in the amount of $70,318.01 (RCV). On 1/29/2025, PTI responded to the Notice advising that a joint re-inspection had been scheduled. The re-inspection had been requested in light of the Notice and based upon questions concerning the cause of loss. 5) On 1/30/2025 the re-inspection by Keystone Experts and Engineers, LLC (“Keystone”) took place in order to determine the cause of reported moisture damage to the interior finishes. Keystone concluded that the water intrusion issues in the home were greater than 14 days and attributable to flashing deficiencies at the roof to wall intersection above the garage and overdriven fasteners piercing the shingle mat above the kitchen – neither of which was caused by a weather related event. As for the moisture damage to the dining room, kitchen and living room, these damages were not determined to have been caused by a weather created opening and/or conditions related to a weather and/or hurricane event. 6) Following the re-inspection, on 2/10/2025, PTI reiterated that coverage was excluded under the policy and therefore no payments are due or owing but extended a pre-suit settlement offer in an effort to extinguish all claims arising out of the subject loss. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. While the CRN references “claim denial, claim delay, and unfair trade practices” as reasons for the notice, it fails to mention specific policy language or factual support in support of said allegations. Contrary to the CRN allegations, the above-referenced timeline of events shows that PTI acted timely in its adjustment of the claim and communications with the Insured and/or Insured representatives, and thoroughly investigated the claim by way of an initial inspection and subsequent Engineer inspection in order to confirm there was no coverage under the subject policy that would warrant a payment and/or settlement offer. As it relates to unfair trade practice, the CRN does not provide any information in support of this and therefore PTI denies said allegations. As for “claim denial” alleged as a reason for notice, PTI maintains that the denial was issued in accordance with its findings during the investigation of the claim and pursuant to the terms of the policy at issue. Furthermore, the CRN asserts that PTI failed to take “any meaningful ensuing action” following receipt of the Insured’s loss package for the claim, which is contrary to PTI’s actions referenced above; specifically, PTI requesting a re-inspection by an Engineer in light of the Insured’s dispute. Furthermore, while PTI acknowledges the estimates submitted by the Insured, the estimate does not contain a report with findings differing from that of PTI’s Field Adjuster and Keystone and/or establishing that a covered loss occurred and/or damages were sustained as a result of Hurricane Milton. Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies of all the statutory violations alleged in the Insured’s CRN. 1) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As stated above, the investigation of the claim failed to reveal any evidence of weather-related damage to the roofing system and/or conditions subject to coverage under the policy at issue. 2) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation. As stated above, the investigation of the claim failed to reveal any evidence of weather-related damage to the roofing system and/or a weather-related opening through which water entered in order to trigger coverage under the policy at issue. Moreover, the Insured does not indicate what portion(s) of the policy coverage became reasonably clear nor what portion(s) of the policy were used to influence settlement. Accordingly, it is impossible to further respond to this allegation. 3) ALLEGED VIOLATION §626.9541(1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006) As the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. 4) ALLEGED VIOLATION §626.9541(1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. RESPONSE The Insured does not indicate what facts and/or policy provisions were misrepresented. Hence, PTI denies this alleged statutory violation. 5) ALLEGED VIOLATION §626.9541(1)(i)(3)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. RESPONSE PTI denies that this alleged statutory violation. As indicated in the numbered paragraphs above, all communications were not only promptly responded to but also promptly acted upon. 6) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory allegation in its entirety. As indicated in the numbered paragraphs above, PTI issued a denial of coverage letter following its inspection by the Field Adjuster at the outset of the claim. Within the letter, the findings of the Field Adjuster were communicated, as well as the relevant policy provisions upon which PTI was relying on. Additionally, upon notice of a dispute as to PTI’s findings, Keystone was retained to conduct a cause and origin assessment and following the inspection, counsel was advised as to PTI’s position with respect to coverage. CONCLUSION /SUMMATION As outlined above, PTI maintains that it has not been in violation of any law and that payment is not due or owing pursuant to the investigation findings, as well as the terms of the policy at issue. The CRN alleges that in order to “cure” the alleged violation, PTI must pay the complete covered loss in the amount of $70,318.01, less any prior payments and less any applicable policy deductible However, PTI stands by its claim decision, has at all times acted in good faith with regard to the claim, and has not breached any duty owed. PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. Should the Department require additional information, please do not hesitate to contact us. Very truly yours, /S/ Cosima Ortiz Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Jared Davis, Esq. 925 S. Federal Hwy Boca Raton, FL 33432 E-mail: Jdavis@kpattorney.com
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