Civil Remedy Notice of Insurer Violations
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Filing Number:     801869
Filing Accepted:  1/17/2025
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Complainant
Last/Business Name *  
JAMES HAMILTON AND ROSALYN HAMILTON   First Name  
Street Address * 8528 GLENCAIRN LANE
City, State Zip * MIAMI LAKES, FL 33016
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JAMES HAMILTON AND ROSALYN HAMILTON   First Name  
Policy # * 79-B3-B751-2 Claim #* 59-65D1-49F
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM STATE FARM FLORIDA INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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.
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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 79-B3-B751-2 INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE 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.

James Hamilton and Rosalyn Hamilton (hereinafter “Insureds”) are homeowners/property owners with an all-risk policy issued by State Farm Florida Insurance Company (hereinafter “Carrier”). On or about March 26, 2024, Insureds’ home located at 8528 Glencairn Lane, Miami Lakes, Florida 33016 sustained significant damage as a result of a wind event. Specifically, a windstorm event created multiple openings to the roof of Insureds’ property. This resulted in interior water damage to various areas of the interior of Insureds’ property including but not limited to, the entryway, dining room, family room, living room, hallway, and kitchen. The Loss is covered under Insureds’ policy issued by Carrier. The Insureds mitigated damages by contacting Clear Restoration, Inc. who performed mitigation services on the subject property. All of the relevant documents were provided to Carrier. Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. 59-65D1-49F to the loss. The Insureds have fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $180,812.96, which was a fair and reasonable assessment for the repair/replacement of damages. After reporting the claim, Carrier retained an unqualified and biased field adjuster to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This adjuster performed a mere cursory inspection of the property. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insureds’ interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier denied full coverage for the loss. This has become a common business practice for Carrier. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insureds and with due regard for the Insureds’ interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters and engineers to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters and engineers to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insureds that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insureds, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insureds’ claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of $180,812.96, less applicable deductible, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: State Farm Florida Insurance Company
Comments
User Id Date Added Comment
admin@bernstein-chackman.com 03-11-2025 Dear Rosalyn and James Hamilton: This letter is to advise you that my firm represents State Farm Florida Insurance Company (hereinafter “State Farm”) in the matter referenced above. This shall serve as State Farm’s response to Civil Remedy Notice number 801869, which was submitted to the Department of Financial Services on behalf of Rosalyn and James Hamilton on January 17, 2025. The Civil Remedy Notice states that State Farm violated §624.155 and §626.9541 by doing the following: not attempting in good faith to settle claims; failing to adopt standards for proper claim investigation; misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; and denying claims without conducting reasonable investigations based upon available information. State Farm denies all allegations of wrongdoing or violation of Florida Law. State Farm has acted in accordance with Florida law and the subject policy in its handling of this claim. Additionally, the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155. State Farm does not waive any deficiencies in the Civil Remedy Notice with the filing of this response. The Notice neglects to include facts which demonstrate that State Farm violated Florida law, fails to identify the specific policy language that was allegedly violated, or include a reasonable cure for the alleged violations. The purpose of the Civil Remedy Notice is to grant the insurer an opportunity to cure the alleged violations of Florida law. Therefore, complainants must identify the specific policy provisions and statutory language that were violated. In addition, complainants must identify what actions the insurer did that violated such provisions and identify what actions must be taken to cure the violations. As such, Florida Statute §624.155(3)(b) states: The Notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as 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 this instance, Civil Remedy Notice 801869 does not include specific facts and circumstances that demonstrate a violation as required by §624.155(3)(b)(2). The notice contains conclusory allegations that State Farm improperly and insufficiently adjusted the claim. As such, the notice fails to comply with §624.155(3)(b)(4). See Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000) & Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The insureds procured policy no.: 79-B3-B751-2 for their home located at 8528 Glencairn Lane, Miami Lakes, FL., 33016. This claim was reported to State Farm on March 26, 2024, with an alleged date of loss of March 26, 2024. During the quality first contact the insured advised State Farm that they had an outside leak in the overhang and did not notice it was leaking. They were told it had been dripping for a long time, maybe a couple of years. Recently the insured noticed something black inside the kitchen cabinet. The insureds failed to utilize water mitigation services for this claim. The Insureds submitted an invoice from Anchor Roofing Company. The invoice is dated March 5, 2024. They billed $2,250.00 for their services and they repaired the leaking roof. Luis Pena inspected the property on April 8, 2024. He observed long-term damages. This claim was denied by letter dated April 8, 2024. The denial letter states: “Based upon the results of our discussions, site inspection, and the investigation, it was determined that there was no covered accidental direct physical loss to the insured property. During our investigation, we went over the recent repairs made to the roof above the rear wall of the kitchen, which was the source of the Ioss. The damage caused to the kitchen back splash and cabinets are a resuIt of wear, tear, deterioration and corrosion from muItipIe weather events and cannot be attributed to a singIe event. Damage that occurs over a period of time from muItipIe storms is not covered under the poIicy and therefore we are unable to extend coverage at this time.” The source of the Ieaking water was reported to be from a roof Ieak that was repaired prior to the caim being fiIed. Therefore, no roof inspection was performed. WhiIe we observed fungus (including moId) at our inspection, there is no coverage for the remediation, testing, or any cost incurred associated with fungus (including moId) as the cause of the damages is not the resuIt of a covered Ioss.” Nicholas Henriquez, PE, of EFI Global, was retained to inspect the property. He inspected on August 5, 2024, and prepared a report which was sent to the insureds. The engineer reviewed the weather data and property information, as well as documents and photographs. He observed a photograph taken during the repair which showed heavy deterioration of the roof truss. The engineer did not observe any wind damage and opined that the moisture intrusion had been occurring for a period of at least many months prior to the reported date of loss. By letter dated December 9, 2024, State Farm explained: A civil remedy notice was submitted to the department on January 17, 2025. However, you have not submitted anything to change State Farm’s coverage determination. In this Civil Remedy Notice the claimant alleges that State Farm violated §624.155(1)(b)(1) by 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 his interests. However, this claim was properly denied. Adjuster Luis Pena inspected the property on April 8, 2024, and observed long-term damage. An engineer inspected the property on August 5, 2024, and opined that the moisture intrusion was ongoing for many months prior to the reported date of loss. There is no coverage under this policy for the claim made. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. However, State Farm properly investigated the claim. Following the reporting of the claim on March 26, 2024, the claim was promptly acknowledged and inspected. State Farm retained an engineer to inspect the claim who opined that the moisture intrusion was long-term. Therefore, the claim was properly inspected, evaluated and properly denied. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. However, no misrepresentations were made. The claim was properly denied based on State Farm’s investigation and evaluation of the claim. The claim determination letter explains the exact reasons why the claim is being denied and even includes all of the policy provisions that apply to bar coverage for the claim made. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information. However, State Farm conducted a more than reasonable investigation based upon the available information. In this case, State Farm provided a detailed claim determination letter, which set forth the facts and policy provisions as to why there is no coverage under the policy for this claim. State Farm’s adjuster inspected the property as well as an engineer. State Farm denies all allegations of non-compliance with Florida law or the subject policy. Furthermore, the civil remedy notice is deficient in that it does not comply with the requirements of Florida Statute §624.155(3)(b). State Farm does not waive any such deficiencies in the filing of this response. Regardless, the accusations raised within the notice are devoid of merit. Thank you for your attention to the above. Very truly yours, /s/ Michael B. Chackman Michael B. Chackman
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