Civil Remedy Notice of Insurer Violations
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Filing Number:     801285
Filing Accepted:  1/15/2025
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Complainant
Last/Business Name *  
BOISETTE   First Name   FARRELL
Street Address * 1836 CONCERT ROAD
City, State Zip * DELTONA, FL 32837
Email Address * FARRELL.PRUDENT@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BOISETTE   First Name   FARRELL
Policy # * H36-258-419853-40 3 Claim #* 058043838
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   LIBERTY MUTUAL INSURANCE COMPANY
NAIC Company Code 23043
 
Name of individual responsible for violation (if any):* ERIC ST. JOHN, MELISSA TOMEY, JASON ROJAS, JONATHAN BRKICH, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, LIBERTY MUTUAL INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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.

627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement; Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Liberty Mutual Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) failing to provide an estimate that complies with the Florida Building Codes; and 10)failing to provide a loss run statement. On or about July 14, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by wind and hail. The areas impacted include but are not limited to the roofing system, gutters, and exterior. The Insured timely submitted a claim on October 12, 2024, to the Insurer for wind and hail damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 058043838 to the loss and sent a field adjuster to inspect the property on October 18, 2024. Then in a letter dated October 30, 2024, the Insurer notified the Insured that it was denying coverage for the loss. This coverage decision is incorrect. Denying coverage for the damage was wrongful as the damages are covered under the policy. Given the denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from wind and hail, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $54,211.56 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. In response, the Insurer retained an engineer who inspected the property on December 3, 2024. Thereafter, the Insurer sent another claims determination letter dated December 12, 2024, advising that it was maintaining its denial of coverage for the Insured's roof damage but extending coverage in the amount of $916.42 for some unknown damage. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspections of the insured property, the Insurer's representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's engineer observed damage to the roof but attributed the cause of this damage to several causes excluded under the policy. However, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. Lastly, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On November 5, 2024, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for the Insured's roof damage as well as wrongfully determining that it would only require $916.42 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Failing to provide an estimate that complies with the Florida Building Codes 10. Shifting the burden of investigating onto the Insured 11. Conducting inadequate investigations 12. Failing to provide a loss run statement 13. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. VIA Certified Mail Liberty Mutual Insurance Company P. O. Box 5014 Scranton, PA 18505 Jason.rojas@libertymutual.com
Comments
User Id Date Added Comment
grant@krapflegal.com 11-04-2025 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice. This Civil Remedy Notice is hereby withdrawn.
elizabeth.tobler@libertymutual.com 03-03-2025 Liberty Mutual Fire Insurance Company (“Liberty”) has received a Civil Remedy Notice (“Notice”). The Florida Department of Financial Services (“DFS”) assigned DFS Notice Number 801285 with an acceptance date of January 15, 2025. As an initial matter, the Notice is deficient because it does not name the correct entity. The Notice identifies “Liberty Mutual Insurance Company” as the Insurer; however, the subject policy was issued by Liberty Mutual Fire Insurance Company (“Liberty”). For that reason alone, the Notice is defective. Nevertheless, and without waiving its right to contest the validity of the subject defective and improper Notice, please allow the following correspondence to serve as Liberty’s formal response to the Notice. On October 12, 2024, the Insured reported a claim for hail damage to the insured property located at 1836 Concert Road, Deltona, Florida, 32837. The loss was reported to have occurred on or around July 14, 2024. Liberty immediately acknowledged the claim and began its investigation. On October 19, 2024, Liberty inspected the property and observed no hail damage to the exterior or roof of the property. As such, no coverage was afforded for the Loss. Liberty sent the Insureds a copy of its coverage determination letter summarizing the outcome of investigation. On November 6, 2024, Liberty received a Letter of Representation from Krapf Legal, P.A. In an effort to re-evaluate the damage, Liberty requested a reinspection of the property. EFI Global, Inc. (“EFI”) inspected the property on behalf of Liberty. EFI’s inspection revealed hail damage to one roof vent and two window screens. No hail damage was observed to the roof shingles. Liberty prepared an estimate to repair all covered damages, however the damage fell below the $1,000 policy deductible. As such, no payment was issued. Liberty sent the Insureds a copy of its estimate and revised coverage determination letter summarizing the outcome of investigation. Liberty has thoroughly investigated the loss and specifically denies the allegations in the Notice. As to the specific statutory violations cited in the subject Civil Remedy Notice, Liberty responds as follows: 624.155(1)(b)(1): Liberty has adjusted this loss and provided Complainant with a coverage decision. Liberty continues to properly investigate this claim to evaluate Complainant’s request for payment. 626.9541(1)(i)(2): Liberty denies misrepresentation of any kind and demands proof of same. 626.9541(1)(i)(3)(a): Liberty avers that it has and continues to properly investigate this claim. 626.9541(1)(i)(3)(b): Liberty denies misrepresentation of any kind and demands proof of same. 626.9541(1)(i)(3)(d): Liberty avers that it has and continues to properly investigate this claim. 626.444(2)(a): Liberty has never received such a request.
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