Civil Remedy Notice of Insurer Violations
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Filing Number:     803863
Filing Accepted:  1/28/2025
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Complainant
Last/Business Name *  
WISH   First Name   DONNA
Street Address * 113 NW PLEASANT GROVE WAY
City, State Zip * PORT ST. LUCIE, FL 34986
Email Address * DWISH61@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WISH   First Name   DONNA
Policy # * 0764162109 Claim #* 7008099809-1
Attorney
Attorney is Applicable
Last Name* STRUBLE First Name * MATTHEW Initial
Street Address* 325 FIFTH AVENUE, SUITE 103
City, State Zip* INDIALANTIC , FLORIDA 32903
Email Address * SERVICE@STRUBLECOHEN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY TRUCK INSURANCE EXCHANGE RELATED TO THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* 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)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

There are no policy provision specifically at issue or in dispute, the policy provides coverage resulting from Wind/Hail but Truck Insurance Exchange has failed to extend coverage for repairs needed for the insured property
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Insurer issued an insurance policy bearing policy number 76416-21-09 with effective dates of coverage from January 26, 2024 to January 26, 2025, which insured the property located at 113 NW Pleasant Grove Way, Port St. Lucie, Florida 34986. The policy was in effect when the property sustained damage on or about May 19, 2024, when damage was caused by Wind/Hail Truck Insurance Exchange (“Insurer”) received notice of the claim for property damage resulting from Wind/Hail, and related damages on or about May 19, 2024. The damage was reported to Insurer which assigned Claim Number 7008099809-1 to the claim and investigated the claim. Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured. Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy
Comments
User Id Date Added Comment
cheryl.perez@farmersinsurance.com 03-07-2025 March 7, 2025 Via E-Mail StrubleCohen 325 5th Ave Ste 103 Indialantic, FL 32903-4226 Delivered by email to: service@strublecohen.com RE: Kevin Wish and Donna Wish Claim No.: 7008099809-1 Dear Matthew Struble: This correspondence is Truck Insurance Exchange’s (“Truck”) response to the Civil Remedy Notice of Insurer Violation No. 803863 filed on behalf of Complainant Donna Wish on January 28, 2025. Complainant alleges that Truck violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 7008099809-1 under an insurance policy issued by Truck to Complainant. Truck welcomes the opportunity to respond to the Notice’s allegations. This notice is invalid due to the failure to include statutorily required information as follows: • The notice does not identify or narrow the person(s) representing the insurer who are most responsible for or who have knowledge of the facts giving rise to the allegations in Complainant’s Notice. • The Complainant has failed to provide “specific policy language that is relevant to the violation, if any,” as required by section 624.155, Florida Statutes. Accordingly, Truck is without proper notice as to the specific violations the Complainant alleges were violated. On the merits, Truck avers it handled Complainant’s claim correctly, fairly, in good faith and with due regard for their interests under Complainant’s policy. A review of our records shows the public adjuster, Ask An Adjuster, reported this loss on September 10, 2024, damage to the Complainant’s property as a result of wind or hail. Despite Complainant’s over three months delay in reporting the loss, Truck conducted a prompt and thorough investigation into this claim. We immediately made contact attempts to schedule the inspection and enlisted the services of an independent third-party vendor, Hancock Claims Consultants. The inspection was completed as scheduled on September 17, 2024 in the presence of our customer. Based on the inspection and photographs of the roof, Truck determined there was no wind, hail or storm related damage to the tile roof. We did observe wear and tear related issues consistent with the age of the roof, including deterioration and mechanical damage. Trucks’ representative found covered and non-covered damage in the bathroom. Coverage applies to the leakage from rain to the bathroom ceiling, however, no coverage applies to the wear and tear related issues or leakage of water to the walls that resulted from a repeating gradual slow leakage or seepage of water on the bathroom wall over the period of weeks, months or years. On September 20, 2024 we provided a partial denial letter of explanation along with our estimate for the covered repairs. This estimated cost, however, fell below the policy’s $2,500.00 deductible. As a result, pursuant to the terms of the policy, no payment was issued to Complainant for the claim. On September 10, 2024 we received a letter of representation from Ask An Adjuster. We promptly acknowledged the letter and ordered a certified policy which was subsequently produced on several dates to include September 24, 2024 and September 26, 2024. On October 10, 2024 the public adjuster provided an estimate for the amount of $92,998.29 and photos. The documentation does not support the presence of additional covered damage to our insured’s property. As such, Truck responded and advised our position on coverage and the claim remains unchanged. On January 29, 2025 we acknowledged your letter of representation and provided the settlement letter and certified policy. Complainant has failed to provide any evidence to support their assertion that Truck failed to properly adjust this claim. The only fact that Complainant alleges to support their allegations that Truck violated Florida law and handled Complainant’s claim in bad faith is that Truck’s adjustment of the claim did not result in payment of Complainant’s exorbitant demand. Truck’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the deductible, conditions, limits, and other terms of the policy. In accordance with these terms, Truck properly adjusted this claim as outlined above. Therefore, contrary to Complainant’s contention, Truck’s coverage determination was made in good faith. Truck denies any breach of any statutory or contractual duties in the handling of Complainant’s claim. While this response is meant to be comprehensive, Truck’s response is based on the limited information provided in the Notice filed by Complainant. Also, this letter or any act or failure to act on the part of Truck or any agent or representative of Truck should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service, available to it by contract or at law as all such right and defenses are hereby specially reserved. We trust that this response addresses the allegations raised in the Notice. Please contact us if you have any questions or should you wish to discuss this matter further. Sincerely, Cheryl Perez, Company Employee Adjuster General Claims Adjuster (913) 274-0230 Truck Insurance Exchange
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