Civil Remedy Notice of Insurer Violations
Login

Filing Number:     802872
Filing Accepted:  1/22/2025
         Print Filing
Complainant
Last/Business Name *  
ARIEL MELENDEZ AND ERICA A. MELENDEZ   First Name  
Street Address * 1866 NW 167TH AVE
City, State Zip * PEMBROKE PINES, FL 33028
Email Address * AMELENDEZ@PRMG.NET
Complainant Type: * Insured
Insured
Last/Business Name*   ARIEL MELENDEZ AND ERICA A. MELENDEZ   First Name  
Policy # * SFLH1198371-08 Claim #* 68943
Attorney
Attorney is Applicable
Last Name* FERNANDEZ First Name * JORGE Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JFERNANDEZ@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SAFEPOINT INSURANCE COMPANY
NAIC Company Code 15341
 
Name of individual responsible for violation (if any):* SIMONE SANFILIPO
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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.
624.155(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’ Milton Hurricane claim. Subsequently, the insureds prepared a loss package in the amount of $206,022.62 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 one hundred and ten 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 $195,708.51, 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 Gloria Sanyustiz at (561)-892-9620 if you have any questions or concerns. Sincerely, Jorge Fernandez Attorney at Law
Comments
User Id Date Added Comment
kpurdy@cftlaw.com 03-21-2025 This firm represents SafePoint Insurance Company (“SafePoint”) in connection with Claim No. 68943 (the “Claim”) under homeowner’s insurance Policy No. SFLH1198371-07 (the “Policy”) for the property located at 1866 NW 167th Ave., Pembroke Pines, FL 33028 (the “Property”), and for the purposes of responding to Civil Remedy Notice of Insurer Violation No. 802872 (the “Notice”) filed by attorney Jorge Fernandez, Esq. on behalf of insureds Ariel Melendez and Erica A. Melendez (the “Insureds”). The Insureds allege that SafePoint violated sections 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), Florida Statutes (collectively, the “alleged violations”). SafePoint denies the alleged violations and objects to the Notice for failure to comply with the statutory requirements of section 624.155, Florida Statutes. Pursuant to section 624.155(3)(b)(2), Florida Statutes, the Notice must state with particularity the facts and circumstances giving rise to the alleged violations. The requirements of section 624.155, Fla. Stat. must be strictly construed. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 878 (Fla. 4th DCA 2021). The Insureds took a shotgun-style approach to the Notice, listing various statutes without even attempting to explain their alleged applicability to the Claim. The Notice falls woefully short of the specificity required to properly place SafePoint on notice of the specific statute and policy provision relevant to SafePoint’s alleged violation. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Such a lack of specificity renders a civil remedy notice deficient and invalid. Id. at 879-80. The Notice also fails to comply with section 624.155(3)(b)(4), Florida Statutes, which requires that every Civil Remedy Notice (“CRN”) must include “reference to specific policy language” relevant to the alleged violation(s). The Notice fails to quote any policy language, instead referring vaguely to the “[l]oss settlement provision” without any further information. The Loss Settlement provision spans two pages of the main policy form and is modified by the Special Provisions – Florida endorsement. The Insureds’ vague reference to the loss settlement provision does not identify the “specific policy language” contained within that provision which they contend is relevant to the alleged violations. See, e.g., Sully v. Scottsdale Ins. Co., No. 23-CV-61967, 2024 WL 1931475, at *3 (S.D. Fla. Mar. 12, 2024), report and recommendation adopted, No. 23-CV-61967, 2024 WL 1857456 (S.D. Fla. Apr. 29, 2024). SafePoint investigated and adjusted the Insureds’ Claim fairly and with diligence. The Insureds allege that they provided immediate notice of the alleged loss, but the Insureds did not report the Claim until nine days after the alleged date of loss. Safepoint immediately notified the Insureds of their duty to protect the property from further damage, and reminded the Insureds of such duty on October 21, 2024, yet the Insureds took no action to protect the Property from further damage. As such, the Insureds failed to comply with their post-loss obligations. SafePoint immediately began its attempts to contact the Insureds to coordinate an inspection of the Property. SafePoint’s field adjuster inspected the Property and observed wear, tear, and deterioration of the fence and prior repairs to the roof. After the inspection, SafePoint retained AKG Roofing & Specialty Services, Inc. (“AKG”) to inspect the Property and determine the cause of damage. AKG immediately began communicating with the Insureds’ public adjuster to coordinate an inspection of the Property. AKG inspected the property on or about November 19, 2024. AKG’s inspection and the resulting report, which was provided to the Insureds, documents that the roof was designed to withstand windspeeds of at least 130 mph, yet wind speeds on the claimed date of loss were only 31 mph. AKG found signs of prolonged weathering due to the advanced age of the roof, as well as multiple prior repair attempts, including prior repairs to the cricket above the garage. AKG found indications of the Insureds’ failure to maintain the roof and nearby crickets. AKG found no signs of any roof-related moisture intrusion into the interior of Property and no signs of any damage due to a windstorm on the reported date of loss. AKG identified cracking due to expansion and contraction, mechanical damage, wear, tear, and deterioration, and a defective roof assembly. AKG did not observe any peril-created opening in the roof or walls of the property through which water intruded into the interior. Based on its investigation, SafePoint determined that the Claim was not covered, as the Policy does not cover damages due to expansion and contraction; wear, tear, marring, deterioration, mechanical breakdown, latent defect, and inherent vice (including of the fence); dry rot; faulty, inadequate, or defective design, specifications, maintenance, workmanship, repair, construction, renovation, remodeling, grading, or compaction; and water damage to the interior of the Property where it did not enter through a peril-created opening in the ceiling or exterior walls. The Insureds accuse SafePoint of “[n]ot 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,” citing section 624.155(1)(b)(1), Florida Statues. As explained above, SafePoint conducted a diligent, good-faith investigation of the Insureds’ Claim, which determined that there is no coverage for the Claim. The Insureds also accuse Safepoint of, “[e]xcept 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,” citing section 624.155(1)(b)(3), Florida Statutes. The Insureds do not identify any facts to support this allegation or even reference two portions of the Policy. Moreover, there is no coverage for the Claim and SafePoint had no obligation to settle any portion of the Claim. Additionally, the Insureds accuse SafePoint of “[f]ailing to adopt and implement standards for the proper investigation of claims,” citing section 626.9541(1)(i)(3)(a), Florida Statutes. The Insureds do not specify what standards SafePoint allegedly failed to adopt or explain how SafePoint’s investigation was allegedly improper. To the contrary, SafePoint timely inspected the Property both with a field adjuster and a licensed roofer. The Insureds also allege that SafePoint “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue,” citing section 626.9541(1)(i)(3)(b), Florida Statutes. However, the only policy provision referenced in the Notice is the Loss Settlement provision. The Insureds do not identify any fact or provision of the Policy that they contend was misrepresented. The Insureds allege that SafePoint “[f]ail[ed] to acknowledge and act promptly upon communications with respect to claims,” citing section 626.9541(1)(i)(3)(c), Florida Statutes. As explained above, SafePoint promptly attempted to make contact with the Insureds upon their untimely reporting of the Claim and promptly inspected the property with both a field adjuster and a licensed roofer. The Insureds failed to identify or provide any details regarding communications which they allege SafePoint did not promptly act upon or acknowledge. The Insures also cite section 626.9541(1)(i)(3)(f), Florida Statute, and allege that SafePoint “[f]ail[ed] 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’ However, SafePoint’s coverage determination letters provided specific policy provisions which excluded the Claim, and SafePoint also provided a copy of the report from AKG upon which SafePoint relied for its coverage determination. The Notice claims that it has been filed due to claim denial, claim delay, and unfair trade practice [sic]. For the reasons detailed at length above, SafePoint’s denial was only issued after a thorough and good-faith investigation of the Claim, including inspections by a field adjuster and a licensed roofer. SafePoint did not delay the Claim. The Notice provides no information regarding any alleged “unfair trade practice.” The Insureds inaccurately set forth facts and circumstances giving rise to the Notice, alleging facts that are patently untrue. For instance, the Notice states that the Insureds “immediately put [SafePoint] on notice” of the Claim. In fact, the Insureds’ public adjuster provided untimely notice of the Claim. The Notice incorrectly states that $206,022.62 is needed to restore the property back to its pre-loss condition, when in fact no covered damages were identified and AKG found that any damages observed were not the result of sudden loss on the claimed date of loss. While the Notice claims that SafePoint failed to prudently inspect the property and come to a fair coverage determination, SafePoint inspected the property on two occasions, with a field adjuster and licensed roofer, respectively. The Notice states that the Insureds complied with all requests made by SafePoint, yet the Insureds failed to protect the property from further damage despite multiple correspondence advising them to do so. The Notice states that SafePoint has intentionally delayed the Claim, but the Insureds simply disagree with SafePoint’s coverage decision and equate SafePoint’s denial to delay. The Insureds allege that SafePoint has 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,” yet the Insureds provide no facts whatsoever to support this meritless allegation. As a cure, the Notice demands full payment of the Insureds’ unfounded demand of $195,708.51 and any applicable policy deductible, as well as statutory interest. The Insureds essentially argue that SafePoint’s denial of the claim constitutes bad faith. However, “[t]he insurer has a right to deny claims that it in good faith believes are not owed on a policy.” Vest v. Travelers Ins. Co., 753 So.2d 1270, 1275 (Fla. 2000). A good faith denial precludes liability “[e]ven when it is later determined by a court or arbitration that the insurer . . . was mistaken.” Id. Safepoint has handled the insured’s claim with diligence, has acted fairly in the adjustment of the claim, has treated the insured with honesty and due regard to the insured’s interests in compliance with the subject insurance policy and Florida law. SafePoint has not violated any of the statutes cited by the Insureds, and denies the alleged violations in the Notice. We trust that the foregoing is sufficient to advise you of SafePoint’s position with regard to this matter, and to respond to the vague and conclusory allegations contained in the Notice. If you have any questions, please contact the undersigned. Respectfully submitted, James Guanciale, Esq., Colodny Fass, 1401 NW 136th Ave., Suite 200, Sunrise, FL 33323, Telephone: (954) 492-4010.
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