Civil Remedy Notice of Insurer Violations
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Filing Number:     802281
Filing Accepted:  1/20/2025
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Complainant
Last/Business Name *  
PEGUERO   First Name   CLARYBEL
Street Address * 6438 WALTHO DRIVE,
City, State Zip * JACKSONVILLE, FL 32277
Email Address * PEGUERO.CLARYBEL@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PEGUERO   First Name   CLARYBEL
Policy # * VAVE007058 Claim #* 76934BFINS
Attorney
Attorney is Applicable
Last Name* WOOD First Name * ANGELA Initial
Street Address* 350 N. LAKE DESTINY ROAD
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * AWOOD@ITSABOUTJUSTICE.LAW
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNDERWRITERS AT LLOYD'S, LONDON
NAIC Company Code
 
Name of individual responsible for violation (if any):* MATTHEW YAWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
624.401(4)(b)(3) However, any person acting as an insurer without a valid certificate of authority who violates this section commits insurance fraud, punishable as provided in this paragraph. If the amount of any insurance premium collected with respect to any violation of this section 3 is $100,000 or more, the offender commits a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, and the offender shall be sentenced to a minimum term of imprisonment of 2 years.
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.
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.

A certified copy of the policy is not in the possession of the Insureds, but has been requested from the insurance carrier. Based on information and belief, the following policy provisions are relevant to this civil remedy notice. Section 1 – Coverage A – Perils Insured Against Section 1- Conditions – Loss Settlement Section 1 – Conditions - Loss Payment
 
* 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 December 2, 2023, the Insured, Clarybel Peguero, suffered damage to her home located at 6438 Waltho Drive, Jacksonville, FL 32277 as a result of a storm event. Prior to the loss, Certain Underwriters at Lloyd’s Lond (“Underwriters”), had issued a policy of insurance (Policy No.: VAVE007058) for the Insured’s property. Said policy was in full force and effect on date of loss and afforded coverage for damage caused by a wind event. Underwriters was notified of the loss by the Insured and assigned claim number 76934BFINS. During the course of Underwriters’ investigation, the Insured made her property available for inspection, provided facts and information about the loss, and complied with Underwriters’ adjustment of the claim. Despite fully cooperating with Underwriters’ investigation, Underwriters severely denied coverage for the Insured’s insurance claim even though there was clear evidence of significant storm damage to the Property. Underwriters came to its coverage determination by ignoring relevant facts and information provided by the Insured’s and her contractors that established the damages to the roof and exterior of the residence were unquestionably the result of a storm event and that her roof needed to be replaced. Most concerning, Underwriters and its representatives either underplayed or misrepresented its own findings in order to avoid having to tender payment on a claim that it knows should be covered pursuant to the terms of the policy. Underwriters ignored relevant weather data, or didn’t disclose it, disregarded important evidence provided by the Insured, and overlooked basic facts and information that contradicted its findings that the damages were caused by factors other than a storm event or covered loss. It is clear that Underwriters has not acted honestly or fairly towards it’s Insured. Underwriters and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope and cause of damages at the residence, and misapplied exclusions in the policy in order to undervalue the Insured’s claim. It has become a general business practice of Underwriters to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for Underwriters to undervalue and misapply exclusions without conducting reasonable investigations and instead base its coverage determinations on evidence it knows to be inaccurate or incomplete. Worst of all, on January 2, 2025, Underwriters notified the Insured that the policy of insurance will be cancelled unless repairs are made. This is a violation of Florida law section 627.4133, Florida Statutes: An authorized insurer may not cancel or nonrenew a personal residential or commercial residential property insurance policy covering a dwelling or residential property located in this state: a. For a period of 90 days after the dwelling or residential property has been repaired, if such property has been damaged as a result of a hurricane or wind loss that is the subject of the declaration of emergency pursuant to s. 252.36 and the filing of an order by the Commissioner of Insurance Regulation. b. Until the earlier of when the dwelling or residential property has been repaired or 1 year after the insurer issues the final claim payment, if such property was damaged by any covered peril and sub-subparagraph a. does not apply. (emphasis added) It is clear that Underwriters is acting in bad faith and essentially putting Ms. Peguero between a rock and a hard place; unable to make repairs due to Underwriters’ denial of the claim and unable to obtain new coverage due to the damage caused by a storm event. In order to cure this civil remedy notice, Underwriters must immediately acknowledge in writing that the damages claimed by the Insured was primarily caused by a covered loss and that replacement of the roof and any other damages caused by the storm event are covered by the policy of insurance. Underwriters must also send notification that Ms. Peguero’s Policy will not be canceled and provide documentation the policy is being renewed. The written acknowledgement should be provided to the Insured’s counsel in writing at Angela A. Wood, at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
Comments
User Id Date Added Comment
dania@sselegal.com 03-13-2025 Re: Response to Civil Remedy Notice of Insurer Violations D.F.S. File No.: 802281 Insurer: Certain Underwriters of Lloyd’s London Insured: Clarybel Peguero Underwriters Claim No. 76934 BF Underwriters Policy No. VAVE007058 Date of Loss: December 2, 2023 Please be advised that our firm represents and is acting on behalf of Certain Underwriters at Lloyds, London Subscribing to Policy No. VAVE007058 (hereinafter “Underwriters”). Underwriters issued an insurance policy to the insured with effective dates of December 13, 2022 - December 13, 2023. This will acknowledge receipt of the Civil Remedy Notice of Insurer Violations (“CRN”) No. 802281 served by Angela Wood. The CRN was filed on behalf of the insured. The claim arises from damage allegedly caused by a windstorm. Underwriters first request that the CRN be rejected as it fails to comply with the requirements set forth in Section 624.155, Florida Statutes, and Florida case law. The CRN generally alleges that Underwriters: failed to attempt in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly towards its insured in violation of §§624.155(1)(b)(1) and 624.155(1)(b)(3). The CRN further alleges that Underwriters (a) failed to adopt and implement standards for the proper investigation of claims; (b) misrepresented pertinent facts; (c) failed to acknowledge and act promptly with respect to the claim; and (d) failed 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 and has violated various provisions of Florida Statute §626.9541(1)(i). Underwriters vehemently denies any violation to §626.9541(1)(i). Underwriters contend that the CRN as filed is deficient as a matter of law as it fails to comply with Section 624.155. 316 Inc. v. Maryland Casualty Insurance Company, 526 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Insurance Corp., 2010 WL 7367059, (S.D. Fla. 2010); Heritage Corporation of South Florida v. National Union Fire Insurance Company of Pittsburgh, PA, 580 F. Supp. 2d 1294 (S.D. Fla. 2008). Pursuant to Section 624.155(3)(b), the notice "shall state with specificity" the following information: 1. The statutory provision, including the specific language, 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; and 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by the section. First and foremost, the CRN fails to allege any facts to notify Underwriters of any of the specific statutory violations at issue. Therefore, the CRN is insufficient as a matter of law. As such, the CRN lacks the requisite specificity required by Section 624.155(3)(b)(3). Finally, the CRN also fails to satisfy Section 624.155(3)(b)(4) in that it fails to reference any policy language. The CRN does not cite any provision of the policy. The failure to cite any policy language allowing Underwriters to investigate the allegations renders the CRN insufficient pursuant to Florida law. As such, the CRN does not satisfy the specificity required by Section 624.155(3)(b)(4). Also, the CRN fails to specify the policy language and provisions that are relevant or applicable to the alleged facts contained in the CRN. Because the CRN fails to identify any specific statutes that actually apply to the allegations, Underwriters is unable to properly respond, and the CRN should be rejected and returned. Additionally, the CRN fails to set forth any specific policy language alleged to have been violated in accordance with Florida Statutes Section 624.155(3)(b)(4). The failure to identify any specific policy provision that is allegedly relevant to the alleged violations prevents Underwriters from addressing any issues regarding the policy and, as a result, the CRN should be rejected. The CRN sets forth various "cures" for the alleged defects. There are also multiple "cures" in the CRN that are improper pursuant to Florida case law, specifically the case of Talat Enterprises, Inc. v. Etna Casualty & Surety Company, 753 So. 2d 1278 (Fla. 2000). The Talat case provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amount due to the insured. Talat also commented that "it naturally follows that for there to be a 'cure,' what had to be 'cured' is the non-payment of the contractual amount due the insured. In the context of a first-party insurance claim, the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to the payment are fulfilled...." As a result, the "cures" in the CRN not relating to payment are improper remedies and contrary to Florida law. The CRN also requires the Complainant to "describe the facts and circumstances giving rise to the insurer's violation as you understand them at this time," the purpose of which is "to enable the insurer to investigate and resolve the claim." Instead of providing facts and circumstances, the CRN contains conclusory, unsupported statements as to the claim. The tenor and inferences of the allegations are wholly without merit and Underwriters denies all of the insured’s allegations. The true facts are as follows: On June 6, 2024, Underwriters received notice of the loss. On June 11, 2024, a third-party adjuster inspected the property. On July 17, 2024, Underwriters issued a denial letter to the insured advising that the field adjuster found no wind damage to the roof or exterior of the dwelling. The field adjuster only noted wear & tear, deterioration, and deferred maintenance conditions to the roof and exterior. On July 22, 2024, Underwriters received an email from the insured disputing the findings of the denial letter. On July 29, 2024, Underwriters responded and advised the insured that a reinspection would be performed by an engineer. On August 15, 2024, a reinspection was performed by Alec Haugdahl, P.E., from Donan Engineering. On August 28, 2024, Underwriters issued a denial letter to the insured advising of the engineer’s conclusions. The engineer confirmed that the roofs were not damaged by wind or hail. He documented cosmetic hail impacts to light gauge metal from ¼ inch to ½ inch. He also documented wear & tear, age-related deterioration, heat blisters, nail pops, and inadvertent man-made damage to the shingles. The policy does not provide coverage for damage due to wear & tear, deterioration, deferred maintenance, and existing damage. The policy also excludes cosmetic damage from a windstorm or hail. Therefore, Underwriters denied the claim and no payment was issued. On November 6, 2024, Underwriters received a Notice of Intent to Litigate pursuant to Florida Statute §627.70152. On November 19, 2024, Underwriters responded to the Notice of Intent to Litigate filed by the insured advising Underwriters continue to stand on the denial. After reviewing the CRN, Underwriters conducted a thorough review of its decision. Underwriters respectfully submits that it has investigated and adjusted the insured's loss in the utmost good faith. Underwriters further assert that it has fully complied with all statutory requirements with respect to this claim and has acted in good faith toward its insured during the investigation and resolution of this claim. While this response is meant to be comprehensive, Underwriters' response is based upon limited information provided in the CRN and the information Underwriters has to date. If the insured or his attorney feels that Underwriters is not in possession of all the facts, it requests that he inform us immediately. Please note that Underwriters' response is not necessarily exhaustive and does not preclude Underwriters from asserting any other valid reason for seeking rejection and return of the CRN. Furthermore, this response or any act or failure to act on the part of Underwriters or any agent or representative of Underwriters should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. Thus, the Civil Remedy Notice of Insurer Violation is without merit. Underwriters acted timely and appropriately to adjust the claim. In the event the insured can demonstrate any loss for which it has not been fairly and fully compensated, Underwriters stands ready to fully compensate the insured for such loss, within the terms of the Policy. With respect to the allegations of the CRN, Underwriters submits that it has at all times acted in the utmost good faith in the handling of the claim and, further, has made payment based upon the estimate and documentation presented subject to the Policy’s terms, conditions, exclusions and endorsements. Please contact us at your convenience in the event we can be of additional assistance to your examination of the Civil Remedy Notice.
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