Civil Remedy Notice of Insurer Violations
Login

Filing Number:     803274
Filing Accepted:  1/24/2025
         Print Filing
Complainant
Last/Business Name *  
ABACO BAY CONDOMINIUM ASSOCIATION INC   First Name  
Street Address * 4601 BAYSHORE DR.
City, State Zip * NAPLES, FL 34112
Email Address * BRIANRC@COMCAST.NET
Complainant Type: * Insured
Insured
Last/Business Name*   ABACO BAY CONDOMINIUM ASSOCIATION INC   First Name  
Policy # * AMC-33014-06 Claim #* CLM-46108
Attorney
Attorney is Applicable
Last Name* DUROCHER First Name * JOSHUA Initial
Street Address* 3310 WEST CYPRESS STREET SUITE 202
City, State Zip* TAMPA , FL 33607
Email Address * JD@THEKDLEGALGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN COASTAL INSURANCE COMPANY
NAIC Company Code 12968
 
Name of individual responsible for violation (if any):* ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEYS AND/OR INDIVIDUALS ASSOCIATED WITH THE CLAIM. SPECIFICALLY, BUT NOT LIMITED TO, SHARON BLOW, SCOTT SHUMAKER, AND RANDY CIARLONE.
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Section I Property Coverages of the appliable policy provides coverage for the reported claim. The Insured has complied with all policy conditions, and there are no exclusions that apply. The Insured believes the Policy language relevant to the violations include all applicable policy coverages, loss payment provisions, loss settlement provisions, valuation provisions and other terms and conditions of the subject policy. In particular, the Insured refers to the following policy language: Coverage A – Dwelling, Coverage B - Other Structures, Coverage C - Personal Property, Coverage D - Loss of Use, Additional Coverages, Law and Ordinance Coverage, and/or Additional Endorsements and Forms. The carrier has failed to issue insurance benefits to its Insured pursuant to the Loss Settlement, Loss Payment, and other Provisions in the applicable policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This complaint is made on behalf of Abaco Bay Condominium Association Inc (“Insured”). Abaco Bay Condominium Association Inc purchased a commercial policy from American Coastal Insurance Company (“Carrier”), Policy No. AMC-33014-06 (the “Policy”), which provided coverage for the properties owned by the Insured (the “Properties”). Abaco Bay Condominium Association Inc paid all premiums associated with the Policy. The Policy was in full force and effect at the relevant times herein. On or about September 28, 2022, the Properties were damaged as a result of Hurricane Ian. The loss caused substantial damages to several Properties, which included damage to their associated roofs, gutters, soffits, downspouts, siding, paint, etc. The Insured notified American Coastal Insurance Company of the damages upon learning of same. The Carrier acknowledged the claim and assigned it Claim No. CLM-46108. Since then, the Carrier has exhibited a blatant, unacceptable failure to properly investigate the claim, in violation of Florida law, and has committed clear bad faith in refusing to properly pay Abaco Bay Condominium Association Inc for the Hurricane claim, and neglecting and delaying the claim as long as possible in order to increase its profits to the detriment of its Insured. Specifically, following receipt of the claim, American Coastal Insurance Company retained an insurance industry-oriented adjuster and engineering firm to evaluate the Properties. American Coastal Insurance Company’s retained field adjuster, Scott Shumaker, and engineer Randy Ciarlone, failed to complete a full and proper evaluation of the claimed damages and ignored clear evidence to support this should be a covered loss. Specifically, the Carrier’s inspection included a cursory visual only view of the damages. Their report and findings establish the cursory nature of the inspection. The report itself states “Not all damage or distress that may be present was necessarily observed or photographed; however, the selected photographs provide an indication of their types, severity, and distribution.” When comparing the photographs taken by the engineer, and those by the Insured’s public adjuster, it is clear the engineer failed to document a vast amount of the damage. While the engineer did note roof scratches and indentations on virtually every roof, only a fraction of the damage was noted/documented by the engineer. In other words, the engineer’s report lacks a significant number of damages – and in turn fails to address and explain said damages - in an attempt to paint a story that contradicts the facts. By doing this, the entire report and integrity of the findings are seriously called into question. The dents and scratches that the engineer did admit to finding were identified as non-storm related damages without any justification. The engineer opined the scratching and denting was consistent with mechanical damage, such as foot traffic, from the initial installation, or from tools being dragged on the roof - but were not wind related. However, the engineer fails to distinguish how one of the purported excluded causes can be differentiated from a covered cause. In fact, this engineer had evidence from a prior loss that should have helped him confirm the claimed damages arose from hurricane Ian, but instead ignored this evidence. Specifically, the engineer had access to pictures taken for the insured’s hurricane Irma claim. The engineer also had the appraisal award from the Hurricane Irma claim. The pictures taken and the appraisal award for the Hurricane Irma loss establish the properties subject to the Hurricane Ian claim did not have any Irma related damage to the siding, no roof denting or scratches, and no damage to the gutters, downspouts, or soffits. In other words, these now evident damages must be from after the Hurricane Irma loss. The Engineer clearly did not include this in his assessment, as he tries to claim the damage are from causes that would predate the Irma loss. The engineer completely fails to explain why the damages to the gutters are unrelated to Hurricane Ian, despite the pictures from the Hurricane Irma loss showing no damage to same. The same is true for the siding, which also has extensive Ian related damage. It is clear what the Carrier’s engineer was retained to find, and he did so regardless of the contradictory evidence. Additionally, the carrier’s engineer’s report offers that the wind speeds on the date of loss were 89 miles per hour. However, multiple well known sources confirm that Hurricane Ian had wind gusts well over 100 miles per hour in Naples. This is yet another example of this engineer including selective information to support his desired, pre-determined conclusion. Based on the cursory inspection by the Carrier’s Field adjuster and engineer, the carrier denied all damages associated with the claim. As outlined in detail above, the engineer’s report simply does not justify a claim denial. The desk adjuster, without confirming if the report accurately allowed for a blanket denial, did so anyway. At this point, the insured had already provided the Carrier with an estimate of the true scope and pricing of the damages and submitted a sworn statement in proof of loss. Since the coverage determination, the carrier has been provided with all documents in the Insured’s possession that were requested by the Carrier. Still, no change in coverage has occurred. Because of Carrier’s refusal to properly adjust the claim, failure to make payment, continued delay of benefits, denying and underpaying of claims, Abaco Bay Condominium Association Inc was forced to hire private counsel to enforce the rights under the Policy and under Florida law. In Florida, the work of adjusting insurance claims engages the Public Trust. American Coastal Insurance Company  has breached this duty by its improper adjustment of this claim. The actions by the Carrier and its adjuster(s) are contrary to the Loss Payment and Valuation provisions of the Policy. Carrier, through its adjuster and persons entrusted to investigate this loss, has failed to investigate this loss adequately and fairly. The Carrier has, based on the above facts to date, committed the following violations: 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 their interests; by 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; by failing to adopt and implement standards for the proper investigation of claims; by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; and by participating in unfair claim settlement practices. This is unconscionable and a gross violation of ethical standards by the Carrier and clear evidence of bad faith by the Carrier who should have evaluated and fairly provided coverage for the true cost of the damages associated with the loss. This failure to investigate and consider adverse information is evidence that Adjusters Sharon Blow, approach investigations in a manner that is prejudicial to its Insureds in violation of Florida Administrative code 69B-220.201(3)(c). American Coastal Insurance Company  has a contractual obligation not to look the other way when confronted with facts revealing the possibility of coverage. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §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 damages and to put the Properties back into the position it was in prior to the loss as quickly as possible. Here, American Coastal Insurance Company has breached this duty. As detailed above, American Coastal Insurance Company has refused or failed to cooperate or “Adjust the Loss” with the Insured during the claims adjustment process in compliance with the Policy’s “Loss Payment” provision. This is a breach of the Policy. American Coastal Insurance Company ’s handling and adjustment of this claim and the conduct of the adjusters, supervisors, management, and individuals associated with or retained by the carrier in this claim to date, evidence that it 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. American Coastal Insurance Company  has also failed and/or refused to thoroughly, accurately, and completely investigate and evaluate Abaco Bay Condominium Association Inc’s claim for damages, and has failed to provide sufficient explanation under the terms of the policy for the coverage position adopted, and has failed to provide their insured with documents which purportedly support the position taken. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute, including any and all bad faith/extra contractual, should the Carrier fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. The Insured also intends to seek punitive damages against the Carrier as it appears that their violations occur with such frequency as to evidence a general business practice and the violations were willful, wanton, and malicious and were in reckless disregard for the rights of the Insured. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, the Insured will consider the allegations contained herein “cured” if Carrier: (1) Immediately tenders an actual cash value payment listed within their public adjuster’s estimate and any mitigation invoices, with no requirement for the Insured to sign a release. While the Insured is requesting that this be done to “cure” this Civil Remedy Notice, the Insured is willing to consider, and may accept, any reasonable counteroffer. Therefore, if Carrier disagrees with the requests, the Insured requests that Carrier make a counteroffer before the end of the “cure period” and provide supporting documentation for any such offer so that they may understand any discrepancies that could exist regarding the estimates.
Comments
User Id Date Added Comment
joseph@becklawpa.com 03-12-2025 Department of Financial Services Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: Civil Remedy Notice of Insurer Violation Complainant : Abaco Bay Condominium Association, Inc. Insured : Abaco Bay Condominium Association, Inc. Policy Number : AMC-33014-06 Claim No. : 4242203 DFS File Number: 803274 Acceptance Date: January 24, 2025 Insurer : American Coastal Insurance Company To Whom It May Concern: Please be advised that we represent American Coastal Insurance Company (“AmCoastal”) in the above-referenced matter. Kindly consider this to be AmCoastal’s report to the Department on the disposition of the alleged violations. AmCoastal maintains that it has not been in any violation of the law and that the Civil Remedy Notice of Insurer Violation (“CRN”) filed by Abaco Bay Condominium Association, Inc. (“Abaco Bay”) is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155 and Form DFS-10-363. As such, AmCoastal objects to the Department’s acceptance of the above-referenced CRN. In order for an insured to maintain a first-party bad faith action against an insurer, the insured must satisfy two conditions precedent: (1) file a civil remedy notice in accordance with the Bad Faith Statute; and (2) obtain a determination of liability and the extent of covered damages pursuant to the underlying insurance contract. See Vest v. Travelers Insurance Co., 753 So. 2d 1270 (Fla. 2000); Lane v. Provident Life and Accident Ins. Co., 71 F. Supp. 2d 1255 (S.D. Fla. 1999); see also Blanchard v. State Farm Mutual Automobile Insurance Co., 575 So. 2d 1289 (Fla. 1991). Abaco Bay has not obtained a judgement against AmCoastal and therefore shall not bring an action pursuant to Fla. Stat. § 624.155. Nonetheless, AmCoastal maintains the CRN is deficient as a matter of law. By way of background, this matter involves alleged windstorm damage that reportedly occurred on or about September 28, 2022 yet was first reported by a public adjusting company, Statewide Claim Services, on or about August 19, 2024, an approximate six hundred ninety-two (692) day delay. At time of reporting the claim, Statewide Claim Services submitted the following documents and/or information on Abaco Bay’s behalf: 1. Notice of purported damage to roofs, siding, fascia, soffit, gutters, and leaks to some interior units; 2. Notice of Representation dated June 4, 2024, approximately seventy-seven (77) days prior to the first notice of loss; 3. Public Adjuster contract dated June 4, 2024, approximately seventy-seven (77) days prior to the first notice of loss; 4. Sworn Statement In Proof of Loss, executed August 16, 2024; and 5. A repair estimate of damage, totaling $7,682,671.45, dated June 24, 2024, approximately fifty-seven (57) days prior to the first notice of loss; Upon receipt of Abaco Bay’s untimely reported claim, AmCoastal assigned claim number 4242203 of which the Insured has alleged is the subject of this CRN. In the course of AmCoastal’s investigation, and contrary to the allegations contained in the CRN, AmCoastal promptly issued correspondences on or about August 20, 2024 acknowledging receipt of the Insured’s claim and providing notice of account manager assignment. In the course of AmCoastal’s investigation, and contrary to the allegations contained in the CRN, AmCoastal again promptly issued correspondences on or about August 26, 2024, reserving its rights due to the untimely report of the subject claim. AmCoastal further requested Abaco Bay comply with the Duties In The Event Of Loss Or Damage policy conditions and requested the following information and/or actions within sixty (60) days: 1. Any engineering or expert reports which address the nature or cause of damage being claimed under American Coastal’s policy, and any photographs taken by the engineer or expert; 2. Any and all Association meeting minutes, agendas, notes, records, logs for the last eight (8) years; 3. Any and all Association internal incident reports, work orders, maintenance records, vendor agreements, repair contracts, repair records, and permits for the last eight (8) years; 4. Any estimates, proposals, invoices, receipts, permits and contracts for roof repair or replacement, and correspondence for work performed or to be performed in relation to the damage reported for this claim, as well as Hurricane Ian; 5. A copy of the Insured’s articles of incorporation, bylaws, declaration of condominium, and other documents creating any association(s), as well as all amendments to these items. 6. A copy of the flood policy and declarations in effect at the time of this claim; 7. A list of any interior units with reported water intrusion resulting from this claim; 8. Any reports, including appraisals, prepared by or on behalf of the Association which speak to the condition of the property prior to the date of loss; 9. Any photographs, videos or otherwise which depict the condition of the property at any time, both before and after the date of the loss; 10. Any other documentation which supports the Association’s contention that the claimed damage was due to a covered cause of loss; 11. Any documentation regarding mitigation services performed at the subject property as a result of this loss, including mitigation invoices or estimates. This request includes all correspondence with any mitigation companies; and 12. A recorded statement by the individual on the Board that has the most knowledge of this claim. The August 26, 2024 correspondence further advised that while in receipt of Abaco Bay’s Sworn Statement In Proof of Loss, AmCoastal’s investigation remained pending, and a joint inspection by a field adjuster and professional engineer was required to expedite review and evaluation of the reported damage. Abaco Bay failed to respond to AmCoastal’s August 26, 2024 request for information and/or documentation. In continued efforts to obtain any and all supporting information, and contrary to the allegations contained in the CRN, AmCoastal maintained thorough investigation efforts and retained a licensed field adjuster, Scott Shumaker of Sedgwick Delegated Authority, and an independent senior forensic engineer, Randy Ciarlone of EFI Global, Inc., to inspect the subject property on AmCoastal’s behalf. The inspection was mutually coordinated to occur September 24, 2024 – September 25, 2024; however, despite mutual coordination, AmCoastal was prevented from conducting inspection of the alleged interior damage at time of the scheduled inspection as Abaco Bay failed to notify and/or coordinate with the applicable unit owners/residents for access. Accordingly, AmCoastal inspected the exterior of the subject property on September 24, 2025 and continued its inspection on October 3, 2024. EFI Global, Inc. implemented a systematic approach to provide a basis for its legitimate scientific and engineering processes. Based upon physical inspections, information obtained from the Florida Building Code, Collier Counter Property Appraiser Office, National Weather Service, site-specific CoreLogic Wind Verification Report, Google Earth, examination of photographs, notes and additional references, together with education, professional training and/or extensive experience in this area of expertise, EFI Global, Inc. ultimately opined that, there was no wind/debris damage observed to the roof or exterior of the buildings as the result of the reported loss. Contrary to the allegations contained in the CRN, EFI Global, Inc’s report identified all investigative efforts and information available for review in forming their opinions, and, as the CRN admits, provided “selected” photographs to “provide an indication” and sampling of the observed damage or distress observed. Contrary to the allegations contained in the CRN, EFI Global, Inc’s written report explicitly cites any and all damage and/or observations to each of the seventeen (17) two-story, multi-unit condominium structures and clubhouse. As is evident from the aforementioned, AmCoastal consistently sought supporting documents or information from the Insured and consistently reported all pending information necessary to evaluate the reported claim. As stated, Abaco Bay failed to respond to AmCoastal’s August 26, 2024 request for information and/or documentation whatsoever so, in accordance with the terms, conditions, definitions, limitations and exclusions of the subject policy, AmCoastal properly issued correspondence dated December 17, 2024 citing that, based on the opinions obtained and information submitted to date, no payment was due or owing. The December 17, 2024 further notified Abaco Bay of its failure to comply with pertinent post-loss duties and obligations applicable to the Insured’s policy. To date, Abaco Bay has failed to produce any documents or information identifying damages incurred directly due to the date of loss alleged. Accordingly, AmCoastal swiftly investigated and adjudicated the loss, afforded a coverage decision in accordance with all Policy conditions and Florida Law, and advised Abaco Bay to report any additional concerns or information to AmCoastal in a prompt manner as per Policy conditions and duties. As is evident from the aforementioned, the allegations contained in the Notice are without merit. On or about January 17, 2025, Abaco Bay produced minimal records responsive to AmCoastal’s August 26, 2024 request for information and/or documentation, including some meeting minutes, Appraisal report, and building proposals. Merely seven (7) days later, Abaco Bay, through legal counsel, filed a CRN against AmCoastal, which is a pre-requisite to a bad faith lawsuit under Florida Statute 624.155. This CRN alleges that AmCoastal engaged in “Claim Denial”. Additionally, the CRN alleges that AmCoastal has violated Florida Administrative Codes and Statutes. On the face, this CRN merely contains accusations without any factual specificity to support them. AmCoastal contends that the CRN filed by the Insured is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 526 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to § 624.155(3)(b), Fla. Stat., 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. . . .; 5. a statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In addition to the criteria cited above, the Florida legislature created “Form DFS-10-363”, which is a Civil Remedy Notice form that lays out an additional fifteen (15) requirements: 1. Complainant’s Name; 2. Complainant’s Address; 3. Complainant’s email address; 4. Complainant type (Insured or otherwise) 5. Insured’s Name; 6. Insurance Policy Number; 7. Insurance Claim Number; 8. Attorney’s Name; 9. Attorney’s Address; 10. Attorney’s email Address; 11. Type of Insurer (authorized or otherwise) 12. Name of Insurer; 13. Address of Insurer; 14. Type of Insurance (Commercial Property & casualty or otherwise); and 15. Reason for Notice. Similar to the five (5) criteria specifically listed in Fla. Stat. § 624.155, the fifteen (15) additional items required by the Department of Financial Services must be correctly stated with specificity in order to satisfy a condition precedent to bringing an action under Fla. Stat. § 624.155. See, Pin-Pon Corp. v. Landmark Am. Ins. Co., 20-CV-14013, 2020 WL 3038576, at * 3-4 (holding that the plaintiff’s Civil Remedy Notice was deficient as a matter of law because the email address listed for the Complainant was the attorney’s email address); Mathurin v. State Farm Mut. Auto Ins, Co., 285 F. Supp. 3d 1311 (M.D. Fla. 2018) (holding that the correct policy number, one of the above listed requirements promulgated by the Florida Department of Financial Services, must be on a Civil Remedy Notice for it to be valid because Fla. Stat. § 624.155 requires a Civil Remedy Notice to have the information required by the Florida Department of Financial Services). To put it simply, a CRN is defective as a matter of law if any of the twenty (20) mandatory items cited above are missing or otherwise incorrect. As already mentioned, AmCoastal maintains the CRN filed by Abaco Bay is defective on its face as it fails to meet the requirements of Form DFS-10-363 and Fla. Stat. § 624.155 on several grounds. First and foremost, the Notice fails to properly name individuals involved in the alleged claims violation as required by Florida Statute § 624.155(3)(b)3. Rather, the CRN cites “[A]ny and all adjusters, supervisors, management, attorneys and/or individuals associated with the claim.” This failure to identify, by name, individuals allegedly involved with the purported claim violations prevents AmCoastal from addressing all alleged issues and is one of the reasons why the Notice does not comply with F.S. § 624.155. Second, with respect to the statutory requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege any relevant conduct on the part of AmCoastal that would actually violate any policy provision or statute. The Notice contains conjecture and supposition as opposed to any facts supporting the conclusory allegations. A written notice which is vague and “shotgun” in nature or is written in general terms fails to satisfy the specificity requirement of the statute. See Heritage Corp. of South Fla., 580 F. Supp. 2d at 1300; 316, Inc., 625 F. Supp. 2d at 1193; see also Rousso, 2010 WL 7367059 at *3-6; Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The CRN filed by Abaco Bay merely contains boilerplate broad language used routinely in a litany of other filings. These CRNs largely include the same generic language, many use the same sentences throughout, and include largely the same allegations. With regards to the CRN, it contains the same generic improper and legally insufficient allegations that are contained within every CRN filed by the Insured’s legal counsel, including the twenty (20) Notices the Insured’s legal counsel has filed in the last ten (10) months alone. Moreover, the Complainant should not be able to simply file the same lengthy generic CRN without containing the requisite specificity. The purpose of a CRN is to place the carrier on notice of specific violations so that they can be corrected during the statutory “cure” period. This CRN fails to meet this requirement and as such, should not be able to proceed on such a defective and improper CRN that contains nothing but accusations and conclusions without any specificity to the purported statutory violations. The CRN alleges that the carrier has, among others, “exhibited a blatant, unacceptable failure to properly investigate the claim”, has “committed clear bad faith” and “neglecting and delaying the claim as long as possible in order to increase its profits”. These allegations as stated are improper, factually incorrect, do not comply with the specificity requirements set forth in Florida Statute 624.155, and are unfairly vague to put the carrier on notice of any alleged violations. As stated, after AmCoastal was placed on notice of alleged windstorm damages approximately six hundred ninety-two (692) day after the loss event, the carrier immediately issued requests for information and/or documentation and promptly retained both a licensed field adjuster and independent professional engineer to inspect and evaluate the insured property. Contrary to the allegations contained in the CRN, AmCoastal sought information and documents from the Insured in order to evaluate the subject matter, affording the Insured every opportunity to provide information to support its claim. As a result of the inspections and Abaco Bay’s failure to comply with its duties and obligations of the policy, AmCoastal was unable to afford coverage. AmCoastal provided Abaco Bay detailed correspondence and reports supporting its position. As such, AmCoastal maintains that it acted fairly and honestly to make a proper determination in light of all the information known and provided. The CRN vaguely attempts to proclaim EFI Global, Inc failed to properly evaluate or investigate the subject matter, asserting characterization of wind speeds based on the Insured’s legal counsel’s position that “multiple well known sources confirm that Hurricane Ian had wind gusts well over 100 miles” without absolutely any specificity of sources or location of wind speeds to the insured property, yet another example of the CRN’s absolute failure to provide relevant specificity of facts or circumstances giving rise to any supposed violations. The CRN further alleges that by way of this conduct, AmCoastal is in violation of Florida Statutes §§ 624.155 and §§ 626.9541. On its face, this is nothing more than a recitation of alleged statutory violations, without providing any specificity as to the facts of the alleged claim, and thus, is statutorily deficient. In fact, many of the alleged violations contradict the facts relevant to the subject claim, such as the Insured’s recitation of §§ 626.9541(1)(i)(3)(a), §§ 626.9541(1)(i)(3)(c) and §§ 626.9541(1)(i)(3)(h), despite a thorough claim investigation, carrier attempts to obtain information, prompt acknowledgement to Insured communications, and detailed coverage explanation. AmCoastal asserts that it has acted in compliance with the terms and conditions of the insurance policy, and all enumerated Florida Statutes and administrative code(s). The allegations contained in the Notice are wholly conclusory and factually incorrect. AmCoastal has reached out to Abaci Bay’s legal counsel on February 4, 2025 and February 25, 2025 to request factual specificity and outstanding documents to support the allegations contained in the Notice to no avail. Third, the Notice fails to satisfy Fla. Stat. § 624.155(3)(b)(4) in that it fails to reference specific policy language relevant to the alleged violation with any degree of specificity. In particular, the Notice cites to certain vast portions of a policy at issue without specifically delineating what specific subsection was violated or how its relevant to the subject claim. In reality, the broad policy headings referenced are in fact not from the subject commercial insurance policy whatsoever and appear to be a recitation of a homeowner policy, again evidencing the “copy and paste” nature routinely found in the Insured’s legal counsel’s CRN filings. The Insured also fails to provide factual specificity for any purported violations of the policy at issue, thereby preventing AmCoastal from responding in regard to what policy language is relevant to the alleged bad faith violation(s). As such, the Notice is insufficient as a matter of law to satisfy the specificity requirement of Fla. Stat. § 624.155(3)(b)(4). Finally, the Notice fails with respect to its requirement to specify how AmCoastal may “cure” the alleged violations. The CRN demands AmCoastal “immediately tender actual cash value payment listen within the public adjuster’s estimate and any mitigation invoices with no requirement for the Insured to sign a release”. The purpose of a Civil Remedy Notice is to provide a carrier with one last opportunity to “cure” the alleged violations. In this instance, the only real “cure” that the Notice is seeking is full payment of a random sum unilaterally determined by the Insured, notwithstanding AmCoastal’s right to investigate and adjust the loss. Interestingly, the CRN demands payment of “actual cash value payment listen within the public adjuster’s estimate” despite the fact the Insured’s Sworn Statement in Proof of Loss only demand replacement cost value of damage. Further, the Notice demands payment of “mitigation invoices” without specificity as to what purported mitigation invoices exist, if any, and if they have been provided to AmCoastal. In addition, the Notice seeks remedies that are “extra-contractual”. A demand for a cure is properly limited to the four corners of the policy and thus the extra-contractual demands render the Notice insufficient on its face. In fact, the Florida Supreme Court has recognized that a Civil Remedy Notice is invalid if the curative action demands more than the payment of contractual benefits under the insurer’s policy. See, Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Subsequent to Talat, Florida courts, and federal courts applying Florida law, reaffirmed the rule articulated in Talat. See, Do v. Geico Gen. Ins. Co., 1:17-CV-23041-JLK, 2019 WL 331295, at *1 (S.D. Fla. Jan. 25, 2019) (finding that a plaintiff’s Civil Remedy Notice was invalid as a matter of law because the curative actions demanded did not concern payment of contractual benefits owned under the insurer’s policy). Based on the information outlined above, AmCoastal maintains that each and every allegation of the CRN is incorrect, and this the CRN should be dismissed. AmCoastal requests that the DFS re-consider its acceptance of the above-referenced CRN and further requests that the DFS provide AmCoastal a list of the guidelines and requirements utilized by the DFS in determining to accept this defective CRN. As outlined above, AmCoastal maintains that it has not acted in bad faith in handling the Insured’s claim, has not been in violation of any law, and has properly fulfilled its obligations to the pursuant to the terms, conditions, exclusions, and exemptions of the Policy regarding coverage for the claimed loss. The subject policy of insurance, governing statutes, and case law only permit submission of a claim and payment for covered losses. While an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. The alleged statutory violations and factual allegations set forth in the Notice are devoid and without merit. AmCoastal further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155 Should the Department require additional information, please do not hesitate to contact us. Sincerely, ASHLEY JOSEPH, 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