Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 803191

Filing Accepted: 1/23/2025

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Complainant

Last/Business Name *

DREAM BEACH, LLC

First Name

Street Address *

4551 BUTTERFLY SHELL DRIVE

City, State Zip *

CAPTIVA, FL 33924

Email Address *

VDYKE@COLORECTALINSTITUTE.COM

Complainant Type: *

Insured

Last/Business Name*		DREAM BEACH, LLC		First Name		ANDREW
Policy # *		HCPC-DP3-429444		Claim #*		925963

Attorney

Attorney is Applicable

Last Name*	FUXA First Name * ANDREW Initial
Street Address*		490 SAWGRASS CORPORATE PARKWAY, SUITE 110
City, State Zip*		SUNRISE , FL 33325
Email Address *		ANDY@GFT.LAW

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

Name of individual responsible for violation (if any):* EMANUELA PAGE, MATTHEW DUTT, SUSAN MAYS, VERNON MOORE, P.E., MARLON BARBER, ANTHONY PARNELL, DUANE WIMBLEY AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	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)(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)(d)		Denying claims without conducting reasonable investigations based upon available information.
	626.9541(1)(i)(3)(e)		Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
	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 promptly notify the insured of any additional information necessary for the processing of a claim.
	626.9541(1)(i)(3)(i)		Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
	626.9541(1)(i)(3)(j)		Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Not all the violations identified herein are directly associated with the policy terms and conditions. Many violations identified herein are associated with the insurance company’s misconduct and failure to abide by the proper Florida statutory and Florida administrative code guidelines for the administration of claims. Nevertheless, specific policy language that is relevant to the violations set forth herein includes, but is not limited to, the following sections of the insurance policy in this case: COVERAGES Coverage A – Dwelling We cover: 1. the dwelling on the Described Location shown in the Declarations, used principally for dwelling purposes, including structures attached to the dwelling; 2. materials and supplies located on or next to the Described Location used to construct, alter or repair the dwelling or other structures on the Described Location; and 3. if not otherwise covered in this policy, building equipment and outdoor equipment used for the service of and located on the Described Location. Coverage D – Fair Rental Value If a loss to property described in Coverage A, B or C by a Peril Insured Against under this policy makes that part of the Described Location rented to others or held for rental by you unfit for its normal use, we cover its: Fair Rental Value, meaning the fair rental value of that part of the Described Location rented to others or held for rental by you less any expenses that do not continue while that part of the Described Location rented or held for rental is not fit to live in. Payment will be for the shortest time required to repair or replace that part of the Described Location rented or held foe rental. If a civil authority prohibits you from use of the Described Location as a result of direct damage to a neighboring location by a Peril Insured Against in this policy, we cover the Fair Rental Value loss for no more than two weeks. The periods of time referenced above are not limited by the expiration of this policy. We do not cover loss or expense due to cancellation of a lease or agreement. PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to the property described in Coverages A and B only if that loss is a physical loss to property; however, we do not insure loss: 2. caused by: h. (1) wear and tear, marring, deterioration; CALENDAR YEAR HURRICANE DEDUCTIBLE WITH SUPPLEMENTAL REPORTING REQUIREMENT – FLORIDA A. Loss By Windstorm During a Hurricane With respect to Paragraphs C. and D., coverage for loss caused by the peril of windstorm during a hurricane which occurs anywhere in the State of Florida, includes loss to: 1. The inside of a building; or 2. The property we cover contained in a building caused by: a. Rain; b. Snow; c. Sleet; d. Hail; e. Sand; or f. Dust; If the direct force of the windstorm damages the building, causing an opening through which the rain, snow, sleet, hail, sand or dust enters and causes damage.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Dream Beach, LLC (the “Insured”) purchased an insurance policy (“Policy”) from Homeowners Choice Property & Casualty Insurance Company (“HCI”) with effective dates of coverage from August 31, 2022, through August 31, 2023, and Policy Number HCPC-DP3-429444, to insure the property located at 4551 Butterfly Shell Drive, Captiva, FL 33924 (the “Property”). On or about September 28, 2022, the Property sustained substantial damage due to Hurricane Ian. This direct and ensuing damage to the Property included damage to the roof system, exterior siding, paint, and other exterior building components. The wind and ensuing water also caused extensive damage to the interior building components, including mechanical, electrical and plumbing systems, insultation, drywall, floors, wall and ceiling finishes, cabinetry and other interior finishes. Furthermore, the ensuing damage from the storm (water intrusion) affected the personal property within the structure – requiring that the affected personal property be restored, cleaned and/or protected. The damage caused by the storm also rendered the subject property unable to reasonably be used for its intended purpose or rented. Hereinafter, this windstorm damage to the Dwelling, Contents, and the covered corresponding financial loss (arising from the inability to rent out/use the windstorm damaged property) shall be referred to as the “Loss”. The Insured promptly reported the Loss to HCI and the Insured did what it could to mitigate the damages. On October 3, 2022, HCI acknowledged receipt of the claim and assigned claim number 925963 (“Claim”) to the Loss. HCI assigned handling of the claim to its in-house adjuster Emanuela Page and outside contracted adjusting team, including an independent field adjuster, Matthew Dutt, to inspect and evaluate the windstorm damage. Due to the size of the Loss, the Insured retained a law firm, Geyer Fuxa Tyler to represent their interests. On or about October 24, 2022, Matthew Dutt inspected the Loss, prepared an estimate and submitted a report to HCI for payment of the Claim. The Insured also had the Loss inspected and damage valuation prepared – which was submitted to HCI for review and payment of the Claim. On or about December 27, 2022, HCI sent a letter, damage estimate and lowball payment of $107,759.97 for the Claim, which represented a fraction of the Actual Cash Value truly owed to the Insured. The letter stated “[o]ur payment to you does not necessarily constitute full and final settlement of this claim. Please notify us of any additional loss or damage to the property and ensure that necessary repairs are made to protect the property from further damage.” Consequently, the Insured’s attorney notified HCI that the estimate was woefully inaccurate and provided additional support for HCI to pay the appropriate amount of the Claim. This came as a surprise to the Insured because during the course of the claim adjustment Matthew Dutt represented his analysis of the Loss included a much broader scope of damage than what was being quantified as the Claim by HCI. Consequently, suspicion arose that HCI was internally manipulating and intentionally lowering the scope of damages that its field adjuster quantified and documented – all with the express purpose of cheating the Policyholders out of benefits they were rightfully owed. On or about January 6, 2023, Vernon Moore, P.E. completed an engineering inspection at the Property. Sadly, despite months of back and forth with HCI’s representatives, HCI never provided Vernon Moore’s report or any further explanation to the Insured regarding the status of the Claim following the January re-inspection. Instead, HCI refused to pay what was owed for the Loss sustained in accordance with the Policy’s terms and conditions. In a flagrant disregard for the Policy and statutory rules for adjusting claims, HCI ignored the well supported claim for loss of use considering the Insured was unable to rent out the Property following the substantial damage sustained from Hurricane Ian. In fact, HCI never provided any explanation as to why it failed to pay the Insured for its months of lost rental income because the insured Property was uninhabitable due to the windstorm damage from Ian. As a result of the underpayment, delay and refusal to pay the correct benefits, the Insured had no choice but to litigate the disputed Claim. And in turn, the Insured agreed to pay the attorney’s fees and costs related to the legal services, and pursuit of their insurance benefits owed under the Policy. To date, HCI has failed and/or refused to pay for the correct amount owed for the Loss and refused to adequately compensate the Insured for the covered damages in this case. Moreover, HCI took action to lessen and/or avoid its liability to the Insured in this case, frustrate its Insured and thwart a fair and equitable resolution of the Claim. HCI knowingly and intentionally refused to acknowledge the full extent of the Loss and in turn, pay what it knew or should have known was owed. Without question, the actions that followed HCI’s receipt of Mr. Dutt’s report were made with the goal of underpaying, delaying and frustrating the insurance claim process. HCI has violated Florida Statute § 624.155(1)(b)(1), by continuously not attempting in good faith to settle these claims when it should have done so if it had acted fairly and honestly towards its Insured. It has also violated Florida Statute § 624.155(1)(b)(3), by failing to promptly settle these obviously covered claims to influence settlement in its favor. HCI knew or should have had reason to know the extent of damages, but still provided an under-inclusive scope of repair, and wholly disregarded and/or underpaid numerous components of the Loss. Rather than work out the dispute, HCI curiously refused to reconsider its erroneous position or send out an unbiased engineer and/or general contractor to perform a property causal analysis and more detailed claim determination. HCI violated Fla. Statute § 626.9541(1)(l)(2) by making material misrepresentations to the Insured for the purpose and with the intent to settle these claims on less favorable terms than those provided and contemplated by the Policy. HCI misrepresented the facts related to the cause of the windstorm damage and the correct scope of the damages owed under the Policy. Evidence of the cause and nature of the damages was presented to HCI, along with facts regarding the full scope of repair and proper payment due. Instead, HCI turned a blind eye to the Policy’s terms and refused to acknowledge its Insured’s requests to pay what was truly owed. In doing so, HCI misrepresented the terms of the Policy as it relates to its obligations to the Insured. HCI has also violated Florida Statute §§ 626.9542(1)(i)(3)(a), 626.9542(1)(i)(3)(b), 626.9542(1)(i)(3)(c), 626.9542(1)(i)(3)(d), 626.9542(1)(i)(3)(e), 626.9542(1)(i)(3)(f), 626.9542(1)(i)(3)(g) and 626.9542(1)(i)(3)(j) for the reasons stated below. HCI failed to adopt and implement standards for the proper investigations of claims. HCI and their representatives are willfully blind and grossly underqualified to handle the loss sustained. In addition to the conduct described above, HCI missed obvious damage, and sought to avoid payment for same, for what was obviously a covered loss. It is also believed, upon information and belief, that HCI knowingly manipulated the damage estimate that it was provided by Mr. Dutt and then lowballed the Insured – a clear violation of § 626.9542(1)(i)(3)(j). Moreover, HCI should have assigned an unbiased engineer to properly evaluate the cause, nature and extent of the damages. It failed to do so. In addition to being placed on notice as to the blatantly mistaken estimates of the scope of the damage for the Claim, it refused to take corrective action that could have avoided escalation, and instead chose to punish the Insured with delays. Following HCI’s January 6, 2023 re-inspection, HCI went more than three months without providing the Insured with a substantive update on the Claim despite numerous requests for same. This misconduct forced the Insured to file suit, which could have been avoided if HCI would have simply treated its customer, the Insured, honestly and in accordance with the property guidelines for the handling of claims. HCI may not deny claims without conducting reasonable investigations based on available information – a violation of § 626.9542(1)(i)(3)(d). Here, HCI breached this duty, time and again by failing and refusing to pay what it knew or should have known was owed, by disregarding its own field adjusters findings, by failing to send out an unbiased engineer to investigate, by refusing to reconsider its estimate of damages and incorrect scope of work and by failing to even acknowledge the Insureds’ claims for damage to personal property and loss of use. HCI’s manipulative and outcome oriented determinative manner of investigating property damage claims fell well below the industry standard for claims handling in this case. Further, upon information and belief, this is not the only time that HCI has acted in the aforementioned improper manner – which is textbook bad-faith claims handling practices. HCI violated § 626.9542(1)(i)(3)(c) and § 626.9542(1)(i)(3)(e) when it failed to engage in any meaningful communications regarding the Claim. Throughout the adjustment of the Claim to the present, HCI has time and again failed to adequately respond to simple issues brought to its attention regarding the Claim that include, but are not limited to, the correct scope of the damage, the corresponding cost of repairs and the Insured’s and loss of fair rental value. Pursuant to Florida Statute § 626.9542(1)(i)(3)(f), HCI has a duty to provide a reasonable explanation in writing to the Insured, of the basis of the Insurance policy, in relation to the applicable facts or law for a denial of a claim or offer of settlement. HCI breached this duty by and through the conduct described herein that includes its delays, failure to provide any meaningful communication on a timely basis, failure to review documents and materials sent, failure to assign an unbiased engineer, refusing to reconsider its faulty lowball estimate and scope and refusal to provide meaningful explanations for its positions. Pursuant to Florida Statute § 626.9542(1)(i)(3)(g), HCI has a duty to promptly notify the Insured of any additional information necessary to process the claim. HCI breached this duty by avoiding answering questions or providing substantive information when necessary. The undeniable truth is that HCI and its personnel knowingly kept pushing a false narrative of the Loss. In clear violations of the Policy and the reasonable standard for claims handling practices. It is these actions, among others as described herein, that constitute a breach of Florida Statute § 626.9542(1)(i)(3)(h) as well. Furthermore, as a general “bad faith” business practice, HCI knowingly employs individuals to evaluate and “revaluate” property damage claims who manipulate the facts and work to low-ball claims. Thereafter, once the consumer or representative of the consumer complains about the undervaluation of the claim to HCI’s claim representative, HCI hires outcome-oriented experts to reinforce the initial low-ball claim valuation rather than hiring experts to provide it with a true analysis of what the scope and cause of damage is. This “bad faith” business practice is commonly found in windstorm damage claims. HCI all too often engages individuals who turn a blind eye to the true amount owed, delay settlement, and ultimately work to increase HCI bottom line through bad-faith claims handling practices. This is evidenced in the significant number of cases that are low-balled and the insured must fight to obtain what HCI knew or should have known was owed from the start. This is particularly problematic because all of these claim representatives and outside consultants hired by HCI, time and again, do not report the fact that windstorm was also a cause and contributed to the loss – instead incorrectly blaming the entire damage on an excluded cause of loss in order to escape liability. HCI expects this result from its engineers, contractors, adjusters and other consultants it engages to protect its interest no matter the cost. This can often be found when HCI attempts to avoid the concurrent cause doctrine followed in Florida that would afford coverage to numerous claimants, despite the fact that non-covered causes (such as wear and tear) may also be present. Again, evidence of this can be found in the thousands of reports HCI received from its experts, finding no windstorm damage to a roof, and then in a subsequent mediation, appraisal, litigation or trial the finder of fact determines that wind damage did in fact exist, the loss was covered and HCI pays. Incredibly, HCI keeps hiring the same outcome-oriented group of adjusters and consultants – all laser focused on providing HCI results that lessen or eliminate its legal responsibility to its insured – primarily by misrepresenting the true facts and circumstances in these windstorm cases. How many times does it have to take for HCI to realize the advisors, adjusters and experts HCI is hiring are getting it wrong again and again? HCI could have stopped using these outcome-oriented individuals, particularly after discovering the flaws in their work thousands of times. HCI has created a sophisticated litigation machine designed to make it very difficult for consumers and ultimately plaintiff attorneys to prosecute first-party property damage claims against it. This practice continues to be a textbook “bad faith” business practice for HCI to have designed such a claims handling framework that from day one sets up a series of traps and landmines to be used in litigation down the road. It should also be noted that HCI approaches most, if not all, of its Florida claims from the start expecting to be sued by its policyholders down the road. How and why? Because it knows that it routinely lowballs and underpays its claims. And because its “bad faith” claims handling leads to so much litigation, HCI set up a sophisticated claims handling structure coupled with an army of in-house litigation adjusters that defend the tens of thousands of improper denials and/or lowball claims valuations. HCI has done all of this instead of simply spending the premiums it charged policyholders on quality unbiased adjusters and experts and paying legitimate claims made against it. In other words, HCI decided long ago to spend millions on defensive claims handling and litigation defense costs rather than paying policyholders what it should have from the beginning – all done to increase its bottom line. This Claim is a classic example of HCI’s bad faith conduct. This bad faith conduct must be stopped and should be punished to protect Florida’s consumers. For the foregoing reasons, HCI is in direct violation of Florida Statutes identified herein and as referenced above. Furthermore, and upon information and belief, the aforementioned actions complained of, among others, were made by HCI so often as to constitute a general business practice, evidencing a motive to enhance HCI profits and designed to cause a detrimental effect to its policy holder. HCI was aware that the Insured’s damages were covered and took advantage of its Insured in an attempt to force them into a disadvantaged position, which HCI hoped would force the Insured to abandon the coverage they were contractually entitled to under the Policy. This is general business practice that had resulted in harm to countless other consumers in Florida. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should HCI fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, HCI must in addition to obviously stopping the bad faith conduct in this case, immediately tender to the Insured the amount that remains owed to them under the specific terms and conditions of the Policy.

Comments

User Id		Date Added		Comment
Legal@hcpci.com		03-18-2025		This is Homeowners Choice Property & Casualty Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by attorney Andrew Fuxa on behalf of Dream Beach, LLC (“Insured”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Regarding an aspect of the claim, HCPCI issued payment for it on the information available to HCPCI and the circumstances at the time of such payment. HCPCI handled the claim in accordance with the policy and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Otherwise, the CRN is deficient. Generally, pursuant to Florida Statutes, Section 624.155, CRNs must identify and set forth statutory provisions insurers allegedly violated in handling insureds’ insurance claims along with specific, relevant insurance contract language and facts and circumstances. The foregoing provides insurers with notice of alleged statutory violations AND the opportunity to cure such alleged violations. Instead of complying with Florida Statutes, Section 624.155, the Insured’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; and relied on inaccurate and conclusory statements. The Insured’s laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, the Insured’s attorney filed a lawsuit based on the claim prior to the filing of this CRN. Regardless of the fact there were no violations in this case, any action by HCPCI to cure violations alleged in the CRN could have been used against HCPCI in the lawsuit. The foregoing shows abuse by the Insured and the Insured’s attorney of the CRN and legal processes. Also and generally, the CRN constitutes an abuse of the CRN process, contravenes the purpose of CRNs, which is to promote resolution of issues in insurance claims. The CRN must be rejected, and it cannot serve as the basis of any action against HCPCI. Upon request by the Florida Department of Financial Services, HCPCI will provide to the DFS detailed correspondence HCPCI provided regarding the claim.

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