Civil Remedy Notice of Insurer Violations
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Filing Number:     801315
Filing Accepted:  1/15/2025
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Complainant
Last/Business Name *  
HEARTH   First Name   PRASAD
Street Address * 4231 ASHTON MEADOWS WAY
City, State Zip * ZEPHYRHILLS, FL 33543
Email Address * PRASADDANANJAYA@GMAIL.COM;
Complainant Type: * Insured
Insured
Last/Business Name*   HERATH   First Name   PRASAD
Policy # * 59C9F0527 Claim #* 5976F065Q
Attorney
Attorney is Applicable
Last Name* MEYER First Name * LOUIS Initial
Street Address* 220 ALHANBRA CIRCLE, SUITE 500
City, State Zip* CORAL GABLES , FL 33543
Email Address * LMEYER@MORGANLAWGROUP.NET
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FIRE AND CASUALTY COMPANY
NAIC Company Code 25143
 
Name of individual responsible for violation (if any):* UNKNOWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Failure to properly investigate claim and with due regard to Insured’s interest
Other : Failure to acknowledge and act promptly to communications regarding claim
* 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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Insured may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within the referenced Homeowner's policy, issued to the Insured including, but is not limited to, the following: Coverage A-Dwelling provisions Coverage B-Other Structures provisions 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. Reasons for Notice: PURSUANT TO SECTION 624.155, F.S. please indicate all statutory provisions alleged to have been violated. Claim Denial Claim Delay Unsatisfactory Settlement Offer Unfair Trade Practice Failure to properly investigate claim and with due regard to Insured’s interest Failure to acknowledge and act promptly to communications regarding claim Civil Remedy Notice of Insurer Violations Coverage C-Personal Property provisions Coverage D-Loss of Use provisions - Additional Living Expenses Additional Coverages provisions - Debris Removal - Reasonable Repairs - Ordinance Or Law Limited Fungi, Wet or Dry Rot, or Bacteria Coverage endorsement The Declarations Page Loss Payment or Loss Settlement provisions Duties in Event of Loss Policy provisions The insurance policy's definition sections The insurance policy's exclusion of coverage provisions
 
* 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 has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier has done everything possible to delay the claim and refuses to issue a claim decision. The insureds reported the Hurricane Milton loss on October 31, 2024, and the carrier is in violation of Florida statutes and the subject policy's loss settlement provision, seventy-seven (77) days ago. Thus, failing to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to thoroughly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The carrier was immediately put-on notice of the insured’s Hurricane Milton claim. To date, the carrier has failed to investigate and assess the scope and amount of the damages for the property’s restoration. Instead, the carrier has failed to inform the insureds of its coverage determination. The insured has now submitted a detailed loss package with extensive supporting documentation in the amount of $65,016.07, minus the Policy deductible, which is needed to restore the property back to its pre-loss condition to the carrier. The carrier is aware of the entire loss package for the claim submitted by the insureds and has still failed to timely communicate with the insured. The carrier’s failure to respond to the insureds’ communications within a timely manner is a direct violation of Florida Statute 627.70131. The carrier’s conduct makes it clear that they are attempting to downplay the extent of the damage and undervalue the damages in its estimate for the sole benefit of maximizing the company’s profits, thereby placing shareholder’s interests ahead of its insureds’ interests ahead of its insureds’ interests. It is obvious that the carrier is not attempting to pay for clearly covered damages owed under the policy and is attempting to delay the claim. This intentional delay with the claim has led to direct prejudice of the insured. To date, the carrier has refused to pay the fully covered amount owed under the policy or even to attempt to treat the claim with good faith. It is clear that the carrier is not treating the insureds with good faith claims handling conduct; failing to pay a claim clearly owed and acknowledged in writing; not adjusting the claim and evaluating the loss properly, promptly, and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claim; not training, supervising, or managing adjusters properly so that prompt and full payment is made, but rather placing the carrier’s interests above the insured’s interests; refusing to pay the full amount owed to the insured even though the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the insured’s loss in a timely manner. The carrier’s actions are in violation of the Loss Settlement provision of the policy, by failing to tender all sums of money due and owing under the policy, as well as the following Florida Statutes: § 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)(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. § 626.9541(1)(i)(3)(g): Failing to notify the insured of any additional information necessary for the processing of a claim. This notice is provided to perfect a right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay all amounts due and owing to the insured in the amount of $65,016.07, minus the applicable deductible for indemnity benefits; and 2) Review and acknowledge receipt of communication made by the insured in regard to the subject claim; Please do not hesitate to contact the undersigned, if you have any questions or concerns. Sincerely, Louis Meyer, Esq. Attorney at Law
Comments
User Id Date Added Comment
vmiller@tlsslaw.com 03-10-2025 Kathryn A. Keller, Esquire, on behalf of State Farm Florida Insurance Company, responded to the Civil Remedy Notice in letter format on March 10, 2025 via electronic mail to: Prasad Herath c/o Louis Meyer, Esq. 220 Alhanbra Circle, Suite 500 Coral Gables, FL 33543 lmeyer@morganlawgroup.net RE: Complainant : Prasad Herath Insureds : Prasad Herath and Lenitha Walpitakudagammanag Claim No. : 59-76F0-65Q Policy No. : 59-C9-F052-7 CRN filing number : 801315 CRN filing accepted : January 15, 2025 Dear Mr. Meyer: As you know, this law firm has the pleasure of representing State Farm Florida Insurance Company (“State Farm”) in connection with the above-referenced claim. We are in receipt of the Civil Remedy Notice of Insurer Violations (“Notice”) you filed on behalf of Prasad Herath. The Florida Department of Financial Services assigned Filing Number 801315 and an acceptance date of January 15, 2025. Please note that State Farm specifically denies the allegations set forth in the Notice and has at all times acted in good faith in responding to the claim. This will confirm that State Farm and the Insureds have reached an amicable resolution of Claim Number 59-76F0-65Q, which is the subject of the Notice, including a full satisfaction of the claim and a cure of all defects alleged in the Notice. The Insureds also withdrew the Notice on February 27, 2025. Thank you for your cooperation in this matter. Sincerely, /s/ Katie Keller KATHRYN A. KELLER ANDREW J. SILVERS cc: State Farm Florida Insurance Company
slascola@morganlawgroup.net 02-27-2025 Attorney withdrawn - SJL
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