Civil Remedy Notice of Insurer Violations
Login

Filing Number:     803096
Filing Accepted:  1/23/2025
         Print Filing
Complainant
Last/Business Name *  
SOUTH LAKELAND DENTAL MANAGEMENT DBA LUMINA DENTAL   First Name  
Street Address * 4912 SOUTHFORK DR
City, State Zip * LAKELAND, FL 33813
Email Address * LUMINASMILES@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SOUTH LAKELAND DENTAL MANAGEMENT DBA LUMINA DENTAL   First Name  
Policy # * VBB103424 00 Claim #* 7030200803
Attorney
Attorney is Applicable
Last Name* ADAMS First Name * JOHN Initial W
Street Address* 1074 BLOOMINGDALE AVE
City, State Zip* VALRICO , FL 33596
Email Address * JADAMS@ADAMSLAWASSOCIATION.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   COVINGTON SPECIALTY INSURANCE COMPANY
NAIC Company Code 13027
 
Name of individual responsible for violation (if any):* BOGDAN TOMUTA
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Other : Failure to provide coverage for a covered loss
Other : Failure to investigate claim in consultation with the insured
Other : Failure to issue all payments due and owing
Other : Failure to address concerns of health and safety at the insured property
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.

Reason for Notice: Claim Delay Unfair Trade Practice Other: Failure to provide coverage for a covered loss Other: Failure to investigate claim in consultation with the insured Other: Failure to issue all payments due and owing Other: Failure to address concerns of health and safety at the insured property PURSUANT TO SECTION 624.155, F.S. please indicate all statutory provisions alleged to have been 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) -- Unfair claim settlement practices. 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)(g) -- Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 627.70131 – (5)(a) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay such claim or a portion of the claim is caused by factors beyond the control of the insurer which reasonably prevent such payment. 626.9541(1)(a)(1) -- Misrepresenting the terms of an insurance policy. 626.9541(1)(i)(2) -- Making a material misrepresentation 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. 69B-220.201(3)(B)(2) – An adjuster shall adjust all claims strictly in accordance with the insurance contract. 69B-220.201(3)(C) – An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201(3)(D) – An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 69B-220.201(3)(E) – An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties. 69B-220.201(3)(F) – An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. 69B-220.201(3)(G) – An adjuster shall promptly report to the department any conduct by any licensed insurance representative of this state which violates any provision of the insurance code or department rule or order. Reference to specific policy language… THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE POLICY COVERAGES, VALUATION PROVISIONS, AND OTHER TERMS AND CONDITIONS OF THE POLICY. SEE: SECTION I COVERAGES; COVERAGE “A” (DWELLING); COVERAGE “C” (PERSONAL PROPERTY); COVERAGE “D” (LOSS OF USE); THE DECLARATIONS PAGE; LOSS PAYMENT AND SETTLEMENT PROVISIONS; DUTIES IN EVENT OF LOSS POLICY PROVISIONS; ALL TERMS AND CONDITIONS OF THE INSURANCE POLICY; AND ALL ENDORSEMENTS TO THE POLICY, INCLUDING ALL FLORIDA ENDORSEMENTS
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

FACTS OF THE CASE: THIS IS THE FIRST CIVIL REMEDY NOTICE FILED IN AN ATTEMPT TO PLEA FOR THE PROPER ADJUSTMENT OF THIS CLAIM. COVINGTON SPECIALTY INSURANCE COMPANY HAS COMMITTED THE FOLLOWING IN INTERACTIONS WITH THE CLAIM: 1) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIMS; 2) PLACING THE FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICYHOLDERS AND CLAIMANTS; 3) FAILURE TO PROPERLY TRAIN, EVALUATE, AND MANAGE ADJUSTERS RETAINED TO REPRESENT THE POLICIES AND PROCEDURES OF COVINGTON SPECIALTY INSURANCE COMPANY; (4) LOOKING FOR WAYS TO DELAY BENEFIT PAYMENTS AND OTHERWISE OR “STONE WALL” CLAIMS; (5) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF OUTSIDE ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY ADJUST AND PAY FULL BENEFITS AVAILABLE TO PARTIES WITH AN INSURABLE INTEREST IN THE PROPERTY. (6) MAKING MATERIAL MISREPRESENTATIONS OF FLORIDA LAW TO THE INSUREDS. ULTIMATELY, THE INSURER FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE A PROPER ADHERENCE TO THE REQUIREMENTS OF FLORIDA STATUTES CHAPTER 624, 626 AND 627 IS NOT OCCURRING. ON SEPTEMBER 11, 2024 THE INSURED’S PROPERTY WAS DAMAGED BY WIND AND WINDSTORM EVENT AND THE INSURED SUFFERED A SUBSTANTIAL LOSS REGARDING THE REAL PROPERTY AND PERSONAL PROPERTY. THEREAFTER THE INSURED CALLED COVINGTON SPECIALTY INSURANCE COMPANY TO REPORT THE CLAIM FOR PROPERTY DAMAGE TO THE PROPERTY AND REQUEST MUCH NEEDED HELP AND DIRECTION AFTER THE INSURED’S LIFE HAD BEEN TURNED UPSIDE DOWN. COVINGTON SPECIALTY INSURANCE COMPANY INVESTIGATED THE CLAIM, ENGAGED AN INSURANCE CLAIMS ADJUSTER. COVINGTON SPECIALTY INSURANCE COMPANY‘S ADJUSTER OR THIRD-PARTY CLAIMS ADMINISTRATOR TOOK PHOTOGRAPHS, INTERVIEWED THE INSUREDS BY TAKING STATEMENTS, AND VISITED AND INSPECTED THE PROPERTY. UPON INFORMATION AND BELIEF, THE CARRIER NOR THEIR THIRD-PARTY CLAIMS ADMINISTRATOR ENGAGED ANY ENGINEERS TO CONDUCT AN INVESTIGATION AT THE PROPERTY IN LIGHT OF THE CLEAR STRUCTURAL DAMAGE. ADDITIONALLY, UPON INFORMATION AND BELIEF, THE CARRIER NOR THEIR THIRD-PARTY CLAIMS ADMINISTRATOR PRODUCED ANY REPORT AS A BASIS OF THEIR CLAIMS DECISION. COVINGTON SPECIALTY INSURANCE COMPANY ISSUED ITS ESTIMATE DENYING ALMOST ALL OF THE DAMAGE TO THE PROPERTY WITHOUT ANY EVIDENCE, PROOF, REPORT OR PHOTOGRAPHS. COVINGTON SPECIALTY INSURANCE COMPANY HAS YET TO EXPLAIN AT ALL WHY IT HAS CHOSEN TO DENY THE DAMAGE OR EXPLAIN WHY DAMAGES ARE SUBJECT TO EXCLUSIONS OR EXCEPTIONS WITHOUT ANY BASIS OR FACTUAL EXPLANATION. COVINGTON SPECIALTY INSURANCE COMPANY CONTINUES TO STALL AND BALK AT THE INSURED’S CONTINUOUS ATTEMPTS FOR HELP AS THEY ARE LEFT IN A DANGEROUS CONDITION AND LEFT ONLY TO THEIR OWN VERY LIMITED RESOURCES TO REPAIR THE DAMAGE. MEANWHILE, THE INSURED CONTINUES TO BE TREATED LIKE A SECOND-CLASS CITIZEN FORCED TO REPAIR WHAT IS CLEARLY A DANGEROUS CONDITION AFTER THE WINDSTORM AND WATER DAMAGE INSPITE OF COVINGTON SPECIALTY INSURANCE COMPANY BEING PLACED ON NOTICE AND BEGGED FOR HELP. IT IS UNCONSCIONABLE THAT COVINGTON SPECIALTY INSURANCE COMPANY COULD ACCEPT PREMIUMS, CONDUCT AN INITIAL INVESTIGATION, AND DENY ALMOST ALL LIABILITY WITHOUT ANY ENGINEERING REPORTS, INVESTIGATIONS OR EXPLANATION. COVINGTON SPECIALTY INSURANCE COMPANY HAS BEEN GIVEN COMPLETE ACCESS TO THE INSURED PROPERTY, HAS NOTICE OF THE CONDITION OF THE PROPERTY THROUGH THEIR OWN INSPECTION AND PHOTOGRAPHS. COVINGTON SPECIALTY INSURANCE COMPANY HAS ALSO BEEN PLACED ON NOTICE THROUGH THE REPEATED CALLS FROM THE INSURED ASKING FOR UPDATES AND REQUESTING FULL PAYMENT TO RETURN THE PROPERTY TO ITS PRE-LOSS CONDITION. INSTEAD OF RE-INSPECTING THE PROPERTY AND ISSUING PAYMENT UNDER THE POLICY, WHICH WAS IN FULL FORCE, COVINGTON SPECIALTY INSURANCE COMPANY HAS INSTEAD IGNORED THE INSURED. ON DECEMBER 10, 2025, THE ADAMS LAW ASSOCIATION, RETAINED BY THE INSURED IN ORDER TO BEG AND PLEA FOR THE CARRIER TO PROPERLY ADJUST THE LOSS, PREPARED A NOTICE OF CLAIM, REQUEST TO RE-OPEN AND RE-ADJUST CLAIM AS WELL AS REQUESTED COPIES OF ALL ADJUSTER REPORTS, ENGINEER REPORTS, ESTIMATES, PHOTOGRAPHS AND DOCUMENTS WHICH SUPPORT THEIR DENIAL. IN THE CORRESPONDENCE, THE LAW FIRM REQUESTED AND DEMANDED THE CARRIER ASSIGN AN ADJUSTER, REVIEW THE CLAIMS FILE AND RE-INSPECT THE PROPERTY TO FULLY AND PROPERTY ADJUST THE LOSS. UNFORTUNATELY, THE CARRIER HAS NOT PRODUCED ANY DOCUMENTS. THE INSURED, THROUGH ITS ATTORNEY, HAS REPEATEDLY REQUESTED THE CARRIER FOR DOCUMENTS WHICH SUPPORT ITS CONTENTION THAT THE DAMAGE WAS CAUSED BY EXCLUSIONS OR EXCEPTIONS OF THE POLICY. AT THIS TIME, THE CARRIER STILL HAS NOT PROVIDED ANY REASON FOR THE CONTINUED CLAIMS DELAY AND HAS OUTRIGHT REFUSED TO EXPLAIN ITS CLAIMS DECISION WITHOUT ANY CLARITY OR DIRECTION. AT THIS POINT, THE CARRIER HAS REFUSED TO PROPERLY ADJUST THE LOSS AND REFUSES TO COMMUNICATE WITH ITS INSURED THROUGH EITHER FORMAL MEANS OR INFORMAL MEANS. THIS INACTION IS PRIMA FACIE EVIDENCE THAT THE CARRIER HAS REFUSED TO ADJUST THE LOSS BY REFUSING TO ISSUE FULL PAYMENT. THE INSURER’S FEIGNED ATTEMPTS TO ADJUST THE LOSS ARE NOTHING MORE THAN TO WRONGFULLY DENY OR DELAY THIS CLAIM. THE ACTIONS TAKEN BY COVINGTON SPECIALTY INSURANCE COMPANY IN THE HANDLING/ADJUSTMENT OF THE HOMEOWNER’S CLAIM WERE WILLFUL, WANTON, IN BLATANT DISREGARD FOR THE RIGHTS OF THE HOMEOWNERS, AND OCCUR WITH SUCH A FREQUENCY AS TO INDICATE A GENERAL BUSINESS PRACTICE IN VIOLATION OF FLA. STAT. §§ 624.155 AND 626.9541. IN FLORIDA THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. COVINGTON SPECIALTY INSURANCE COMPANY HAS BREACHED THIS DUTY BY ITS IMPROPER HANDLING OF THE INSURED’S CLAIM OF LOSS. COVINGTON SPECIALTY INSURANCE COMPANY HAS FAILED TO CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION TO EVALUATE CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES RESULTING IN STATUTORY VIOLATIONS SET FORTH ABOVE. COVINGTON SPECIALTY INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE AND EVALUATE THE INSURED’S INSURANCE CLAIM FOR DAMAGES. FLA. STAT. § 624.02 DEFINES INSURANCE AS A CONTRACT WHEREBY ONE UNDERTAKES TO INDEMNIFY ANOTHER OR PAY OR ALLOW SPECIFIED AMOUNT OR A DETERMINABLE BENEFIT UPON DETERMINABLE CONTINGENCIES. INHERENT IS THE FACT THAT PAYMENT MUST BE MADE TIMELY AND PROMPTLY SO THAT THE INSURED MAY MITIGATE HIS/HER DAMAGES AND TO PUT THEM BACK INTO THE POSITION THEY WERE PRIOR TO LOSS AS QUICKLY AS POSSIBLE. COVINGTON SPECIALTY INSURANCE COMPANY BREACHED THIS DUTY. THE ACTIONS TAKEN BY COVINGTON SPECIALTY INSURANCE COMPANY IN THE HANDLING OF THE INSURED’S CLAIM WERE WILLFUL, WANTON, AND IN DISREGARD OF THE RIGHTS OF ITS INSURED AND OCCUR WITH SUCH A FREQUENCY AS TO INDICATE A GENERAL BUSINESS PRACTICE, AND ARE IN VIOLATION OF FLA. STAT. §§ 624.155 AND 626.9541. COVINGTON SPECIALTY INSURANCE COMPANY’S ACTIONS AMOUNT TO BUT ARE NOT LIMITED TO THE FOLLOWING: 1. FAILURE TO RECOGNIZE A CLAIM 2. FAILURE TO RESPOND TO AN INSURED’S REQUEST TO ADJUST THE LOSS 3. FAILURE TO ASSIGN AN ENGINEER TO INSPECT THE DAMAGE 4. FAILURE TO COMMUNICATE TO AN INSURED AFTER A CLAIM WAS MADE 5. CLAIM DELAY 6. NOT CONDUCTING FULL AND PROMPT INVESTIGATION 7. FAILING TO PROVIDE REPORTS REQUESTED 8. NOT TREATING POLICYHOLDERS WITH GOOD FAITH CLAIMS CONDUCT 9. NOT ADJUSTING CLAIMS AND EVALUATING LOSSES PROPERLY, PROMPTLY AND FAIRLY TO PROVIDE FULL AND PROMPT INDEMNITY TO THE INSURED 10. FAILING TO IMPLEMENT PROPER STANDARDS FOR THE ADJUSTMENT AND INVESTIGATION OF CLAIMS 11. NOT TRAINING, SUPERVISING OR MANAGING ADJUSTERS PROPERLY SO THAT PROMPT AND FULL PAYMENTS ARE MADE, BUT RATHER PLACING THE COMPANY’S INTERESTS BEFORE THOSE OF THE POLICYHOLDER. 12. FAILING TO OFFER ALL COVERAGES AVAILABLE IN SPITE OF THE CLEAR EVIDENCE OF WINDSTORM AND WATER DAMAGE. THEREFORE, TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, COVINGTON SPECIALTY INSURANCE COMPANY MUST: (1) ADMIT FULL COVERAGE FOR THE INSURED’S LOSS; (2). TENDER COVERAGE APPLICABLE FOR THE DAMAGE CAUSED BY THE WIND AND WATER DAMAGE IN THE AMOUNT OF $189,995.13. (3). PAY STATUTORY INTEREST ON THE AMOUNT OF UNPAID CONTRACT DAMAGES FROM THE DATE OF THE LOSS TO THE PRESENT TIME PURSUANT TO F.S. §627.70131, AND PAY REASONABLE COSTS INCURRED. A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN SENT TO THE FOLLOWING PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE: COVINGTON SPECIALTY INSURANCE COMPANY ATTN: CLAIMS DEPARTMENT AND BOGDAN TOMUTA 945 EAST PACES FERRY RD, STE 1800 ATLANTA, GA 30326-1160 SENT VIA EMAIL & FAX: REPORTCLAIMS@RSUI.COM AND BTOMUTA@WHEELER-DEFUSCO.COM (404) 231-3755; (954) 332-0897
Comments
User Id Date Added Comment
rhardeman@rsui.com 02-27-2025 February 27, 2025 Certified Mail Return Receipt Requested John W. Adams, Esq. Adams Law Association, P.A. 1074 Bloomingdale Ave. Valrico, FL 33596 Re: Response to Civil Remedy Notices of Insurer Violation CRN Number: 803096 Acceptance Date: January 23, 2025 Claimant: SOUTH LAKELAND DENTAL MANAGEMENT DBA LUMINA DENTAL Claim Number: 7030200803 Policy Number: VBB103424 00 Date of Loss: September 11, 2024 Dear Sir/Madam: The law firm of Butler Weihmuller Katz Craig, LLP represents Covington Specialty Insurance Company (“Covington”) in responding to the above-referenced Civil Remedy Notices of Insurer Violation, filing number 803096, accepted by the Department of Financial Services on or about January 23, 2025 (the “Notice”), on behalf of SOUTH LAKELAND DENTAL MANAGEMENT DBA LUMINA DENTAL (“the Claimant”). As a result, this correspondence is timely under the Florida Statutes. The Notice is statutorily deficient, and therefore invalid, for multiple reasons. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021); Demase v. State Farm Florida Ins. Co., 351 So. 3d 136 (Fla. 5th DCA 2022). Generally, the Notice is riddled with errors and is devoid of any specific information supporting the alleged violations. These issues not only render Notice defective, but they also deprive Covington of the ability to respond to, and more importantly, cure the grievances contained in, the Notice. First, the section related to the relevant policy provisions is deficient. The Notice states that “ALL APPLICABLE POLICY COVERAGES, VALUATION PROVISIONS, AND OTHER TERMS AND CONDITIONS OF THE POLICY” are relevant to the purported violations. The Notice then directs Covington to, SECTION I COVERAGES; COVERAGE “A” (DWELLING); COVERAGE “C” (PERSONAL PROPERTY); COVERAGE “D” (LOSS OF USE); THE DECLARATIONS PAGE; LOSS PAYMENT AND SETTLEMENT PROVISIONS; DUTIES IN EVENT OF LOSS POLICY PROVISIONS; ALL TERMS AND CONDITIONS OF THE INSURANCE POLICY; AND ALL ENDORSEMENTS TO THE POLICY, INCLUDING ALL FLORIDA ENDORSEMENTS This policy at issue is a commercial non-residential policy. Thus, it is unclear to Covington how Coverages A, C, and D related to the boilerplate allegations in the Notice. Additionally, by stating that all of the policy provisions are relevant, the Claimant has done nothing to pinpoint or explain what the true issues are. It provides as much information as leaving this section blank. We note that the instant Notice looks almost identical to others filed by the attorney of record. See Filing Number: 807557, accepted February 19, 2025; Filing Number: 800187, accepted January 9, 2025; and Filing Number: 794055, accepted November 25, 2024. This impersonal and boilerplate approach frustrates the purpose of the Notice, which is to resolve true grievances. The section describing the facts giving rise to the Notice does not provide any specific information demonstrating how Covington’s conduct amounts to bad faith. Nestled in a dense forest of conclusory and unsubstantiated allegations, the only real grievance alleged in the Notice is that the Claimant disagrees with Covington’s coverage decision. This does not amount to bad faith. The Notice cites six reasons for the Notice and claims Covington violated nine statutory provisions, and six administrative code provisions. However, the Notice fails to provide sufficient facts or any meaningful explanation as to how or why these provisions apply to Covington’s handling of the claim. We address each in turn: 624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all 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. The narrative provided in the Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Notice simply contains generalized and unfounded accusations that Covington refused to properly settle the claim in good faith with no specific factual examples to support the contention that Covington did not attempt in good faith to settle the claim at issue. Covington disputes the allegation it violated Florida Statute § 624.155(1)(b)(1). 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. The narrative provided in the Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Notice simply contains generalized and unfounded accusations that Covington made a material misrepresentation to affect a settlement. Covington disputes the allegation it violated Florida Statute § 626.9541(1)(i)(2). 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. The narrative provided in the Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Notice simply contains conclusory and inaccurate accusations that Covington failed to conduct a proper investigation of the claim with no specific factual examples to support the contention that Covington has failed to adopt and implement proper standards for the adjustment and investigation of claims. Covington disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(a). 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. The narrative provided in the Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Notice simply contains generalized and unfounded accusations that Covington misrepresented policy provisions relating to coverages at issue. The Notice contains no explanation, much less any allegation, as to what fact or policy provision Covington is alleged to have misrepresented. Notably, the narrative of the Notice contains no specific allegation that Covington misrepresented any pertinent fact or policy provision at issue. Covington disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(b). 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. The narrative provided in the Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Notice simply contains conclusory and inaccurate accusations that Covington failed to act promptly on communications during the claim. However, the Notice provides no specific factual examples to support this allegation. Covington disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(c). 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. The Notice lacks the sufficient factual basis for the selection of this statutory provision. Covington disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(g). The Notice also cites the following sections in the Policy section. The Notice statute requires strict compliance. Failing to allege all of the violated statutes in the appropriate section of the Notice renders the Notice defective. 627.70131 – (5)(a) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay such claim or a portion of the claim is caused by factors beyond the control of the insurer which reasonably prevent such payment. 626.9541(1)(a)(1) -- Misrepresenting the terms of an insurance policy. 626.9541(1)(i)(2) -- Making a material misrepresentation 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. Like the other provisions, the Notice lacks the requisite level of information demonstrating how these statutes were violated or relevant to Covington’s adjustment of the claim. Covington disputes the allegation it violated Florida Statute § 627.70131(5)(a); § 626.9541(1)(a)(1); or § 626.9541(1)(i)(2). The Notice cites six provisions of the Florida Administrative Code, but similar to the statutory provisions, does not provide sufficient facts or any meaningful explanation as to how or why they apply to Covington’s handling of the claim. We address each of these provisions in turn: 69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the insurance contract. The narrative provided in the Notice does not provide sufficient factual basis for the selection of this provision. Rather, the Notice simply contains conclusory and inaccurate accusations that Covington failed to adjust the claim strictly in accordance with the insurance contract with no specific examples to support this contention. Covington disputes the allegation it violated Florida Administrative Code 69b-220.201(3)(b)(2). 69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. The narrative provided in the Notice does not provide sufficient factual basis for the selection of this provision. Rather, the Notice simply contains conclusory and inaccurate accusations that Covington approached the investigation, adjustment, and settlement of this claim in a manner prejudicial to the insured, but the Notice provides no specific examples to support this contention. Covington disputes the allegation it violated Florida Administrative Code 69b-220.201(3)(c). 69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. The narrative provided in the Notice does not provide sufficient factual basis for the selection of this provision. Rather, the Notice simply contains conclusory and inaccurate accusations that Covington did not make truthful and unbiased reports of the facts after the investigation was completed. However, the Notice provides no specific examples to support this allegation. Covington disputes the allegation it violated Florida Administrative Code 69b-220.201(3)(d). 69B-220.201(3)(e) An adjuster shall handle every adjustment and settlement with honesty and integrity and allow a fair adjustment or settlement to all parties. The narrative provided in the Notice does not provide facts supporting selection of this provision. Rather, the Notice simply contains conclusory and inaccurate accusations that Covington did not act fairly or with honesty and integrity. The Notice provides no specific examples to support this allegation. Covington disputes the allegation it violated Florida Administrative Code 69b-220.201(3)(e). 69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. The narrative provided in the Notice does not provide sufficient factual basis for the selection of this provision. Rather, the Notice simply contains conclusory and inaccurate accusations that Covington did not act with dispatch and due diligence in achieving a proper disposition of the claim. However, the Notice provides no specific examples to support this allegation. Covington disputes the allegation it violated Florida Administrative Code 69b-220.201(3)(f). 69B-220.201(3)(g) An adjuster shall promptly report to the department any conduct by any licensed insurance representative of this state which violates any provision of the insurance code or department rule or order. The Notice does not provide a sufficient factual basis for the selection of this provision or any specific examples of how it was violated. Covington disputes the allegation it violated Florida Administrative Code 69b-220.201(3)(g). As outlined above, the Notice is vague, inaccurate, and inflammatory. This serialized and impersonal approach frustrates the purpose of the Notice and falls short of the specificity requirements set out by Florida Statutes. Claimant has failed to provide Covington with specific information supporting the alleged violations. Without that information the Notice is defective. Covington is unable to respond to, and more importantly cure, the purported grievances contained in the Notice. Covington specifically denies and disputes the allegations contained in the Claimant’s defective Notice. The allegations contained within the Notice are without merit. Covington’s handling of the subject claim was conducted in good faith and in accordance with the requirements of law and the subject policy. Thank you for consideration of this matter. Sincerely, BUTLER WEIHMULLER KATZ CRAIG LLP /s/ Vincent Fernandez Vincent A. Fernandez, Esq. /s/ William R. Lewis William R. Lewis, Esq.
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