Civil Remedy Notice of Insurer Violations
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Filing Number:     804028
Filing Accepted:  1/29/2025
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Complainant
Last/Business Name *  
SANDRA GOMEZ AND RUBELIO GOMEZ   First Name  
Street Address * 5476 NW 49TH COURT
City, State Zip * COCONUT CREEK, FL 33073
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SANDRA GOMEZ AND RUBELIO GOMEZ   First Name  
Policy # * PFL353602-08 Claim #* CFL24607267
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM PEOPLE’S TRUST INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
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.
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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER PFL353602-08 INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Sandra Gomez and Rubelio Gomez (hereinafter “Insureds”) are homeowners/property owners with an all-risk policy issued by People’s Trust Insurance Company (hereinafter “Carrier”). On or about October 9, 2024, Insureds’ home located at 5476 NW 49th Court, Coconut Creek, Florida 33073 sustained significant damage as a result of a windstorm. Specifically, Hurricane Milton created multiple openings to the roof of Insureds’ property. This resulted in interior water damage to various areas of the interior of Insureds’ property including but not limited to, the entry, dining room, living room, kitchen, and master bedroom. The Loss is covered under Insureds’ policy issued by Carrier. The Insureds mitigated damages by contacting Strings Service LLC who performed mitigation services and placed a tarp on the roof of the subject property. All of the relevant documents were provided to Carrier. Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. CFL24607267 to the loss. The Insureds have fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $106,677.68, which was a fair and reasonable assessment for the repair/replacement of damages. String Services LLC has an outstanding balance in the amount of $10,049.92 for their mitigation services and tarp placement. After reporting the claim, Carrier retained an unqualified and biased field adjuster, Ricardo A. Peña, to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This adjuster performed a mere cursory inspection of the property on December 14, 2024. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insureds’ interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property. Worse still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier denied full coverage for the loss. This has become a common business practice for Carrier. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insureds and with due regard for the Insureds’ interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insureds that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insureds, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insureds’ claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of $106,677.68, and String Services LLC in the amount of $10,049.92, less applicable deductible, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: People’s Trust Insurance Company
Comments
User Id Date Added Comment
bfrankel@gmail.com 02-21-2025 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of its Insureds, Sandra and Rubelio Gomez (“Insureds”). In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. To be more specific, the CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information the department may require: (1) The statutory provision, including the specific language of the statute, 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. If the person bringing the civil action is a third-party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. (5) A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted properly and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insureds’ CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimants right to pursue civil remedies under Florida Statutes.   1) On 10/29/2024, “Natalie” with Kingwell PA (“Insureds’ Public Adjuster”) called to report damage to the roofing system, as well as ceilings leaks in the living room and master bedroom. The representative further advised that the Insured was having a company tarp the roof. 2) Following the reporting of the loss, on 11/8/2024, PTI issued a Request for Information Letter seeking all estimates, invoices, documents, and photographs related to the claim for damages, as well as a Sworn Proof of Loss and detailed estimate. In response thereto, PTI received a copy of an estimate prepared by Kingwell in the amount of $101,003.30, as well as documents related to tarping services. A certified copy of the policy was provided to the Insureds’ Public Adjuster on 11/14/2024. 3) Subsequently, on 12/14/2024, a Field Adjuster inspected the property to determine the nature and scope of the reported damage. At the time of the inspection, the Insured, Sandra Gomez, was present and reported roof leak damage to the linen closet, while the PA appeared telephonically and reported roof leak damage to the living room and master bedroom. PTI’s Field Adjuster observed roof leak damage to the linen closet ceiling, but there was no evidence of roof leak damage to the living room, master bedroom or other rooms. As for the roofing system, there was no evidence of windstorm damage or damage caused by a covered peril. Instead, the Field Adjuster noted conditions consistent with age related deterioration. 4) Upon completion of its investigation, PTI issued a coverage determination letter on 12/20/2024. Within the letter, the Insureds were advised that there was no coverage under the policy at issue and cited the relevant policy language. Specifically, the inspection revealed no evidence of any storm-related damage to the roof or exterior and the interior water damage was attributed to a roof leak(s) caused by age-related wear and tear and faulty, inadequate, or defective installation, maintenance, or repairs of the roofing system. The letter further advised that if the Insureds believed there was any additional information or documentation not previously provided that would require a reassessment of PTI’s decision to please submit that information for review and consideration. 5) After the issuance of its coverage letter, PTI received a Notice of Intent to Initiation Litigation (“NOI” Notice No.: 227975) filed on 1/29/2025. The Notice attached the estimate prepared by the Insureds’ Public Adjuster, in addition to the invoices for mold, and tarping, and a copy of the Civil Remedy Notice filed. On 2/11/2025, PTI responded to the Notice advising that a joint re-inspection had been scheduled. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law, and has not engaged in any claim delay or improper investigation methods that the CRN alleges. While the CRN references unfair trade practice and claim denial as reasons for the notice, it fails to mention specific policy language or factual support in support of said allegations. Moreover, said allegations are contrary to the facts discussed above. PTI maintains that the denial was issued in accordance with its findings during the investigation of the claim and pursuant to the terms of the policy at issue and that the denial letter adequately explained the basis of the denial as well as the relevant policy language. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. With respect to the factual allegations, PTI acknowledges that the Insured has submitted mitigation documents, and an estimate, but nothing that would require PTI to reassess its decision in this matter, such as a report from an engineer or similar expert whose opinion of what caused the reported damage(s) differs from the findings of PTI’s Field Adjuster. Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies all the statutory violations alleged in the Insureds’ CRN. 1) ALLEGED VIOLATION §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: RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As stated above, the investigation of the claim failed to reveal any evidence of weather-related damage to the roofing system and/or a weather-related opening through which water entered in order to trigger coverage under the policy at issue. 2) ALLEGED VIOLATION §626.9541(1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006) As the Insured has not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. 3) ALLEGED VIOLATION §626.9541(1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. RESPONSE The Insured does not indicate what facts and/or policy provisions were misrepresented. Hence, PTI denies this alleged statutory violation. Moreover, PTI has been honest and fair in the evaluation of the claim, and therefore demands that Claimants provide documentation to support this statutory allegation. 4) ALLEGED VIOLATION §626.9541(1)(i)(3)(d) – Denying claims without conducting reasonable investigations based upon available information. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As mentioned above, the Insured has not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented. Furthermore, PTI promptly investigated the claim, and a coverage decision was made within 6 days after the post-loss property inspection. This allegation is baseless and the alleged violation is emphatically denied. CONCLUSION /SUMMATION As outlined above, PTI maintains that it has not been in violation of any law and that payment is not due or owing pursuant to the investigation findings, as well as the terms of the policy at issue. The CRN alleges that in order to “cure” the alleged violation, PTI must immediately accept full coverage and pay the amounts requested to the Insured and mitigation companies. However, PTI stands by its claim decision, has at all times acted in good faith with regard to the claim, and has not breached any duty owed. PTI 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. Very truly yours, /S/ Cosima Ortiz Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Clayton Kuhn, Esq. 2110 West Platt Street Tampa, FL 33606 E-mail: clay@thekrfirm.com
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.

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DFS-10-363
Rev. 10/14/2008