Civil Remedy Notice of Insurer Violations
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Filing Number:     804160
Filing Accepted:  1/29/2025
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Complainant
Last/Business Name *  
FLOOD   First Name   PATRICK
Street Address * 595 ALEXANDRA AVENUE SW
City, State Zip * VERO BEACH, FL 32968
Email Address * STEVEN@PLG.LAWYER
Complainant Type: * Insured
Insured
Last/Business Name*   FLOOD   First Name   PATRICK
Policy # * 79-CE-S757-1 Claim #* 59-73Q752J
Attorney
Attorney is Applicable
Last Name* HOFFMAN First Name * STEVEN Initial
Street Address* 1790 HIGHWAY A1A, SUITE 209
City, State Zip* SATELLITE BEACH , FL 32937
Email Address * STEVEN@PLG.LAWYER
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* STATE FARM FLORIDA INSURANCE COMPANY'S ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS AND CONTRACTORS WHO HANDLED THE CLAIM, SPECIFICALLY THE DESK ADJUSTER.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Other : Misrepresentation
* 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, duties after loss, and coverage provisions of Policy Number 79-CE-S757-1, including the declarations page and all endorsements to the Policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Claim # 59-73Q752J; DOL: April 26, 2023 Patrick Flood (“Insured”) is the owners of a property with a policy of insurance issued by State Farm Florida Insurance Company (“Carrier”). The Insured’s residence is located at 595 Alexandra Avenue SW, Vero Beach, FL 32968 (the “Property”). On April 26, 2023, a wind and hail event caused extensive damage to the Property. The Insured timely reported an insurance claim for this damage to the Carrier and fully cooperated with all requests for inspection and information. Insured provided all requested documentation, if any, and complied with all post loss policy conditions reasonably and timely requested. The Insureds obtained representation from a public adjuster and an estimate for repair of dwelling for $86,214.85, deductible subtracted, with supporting documentation and photographs. Upon reporting the loss, the Carrier assigned a field adjuster who advised the Carrier they did not observe any wind or hail damage and issued a denial letter. The Insured requested a copy of the Carrier’s estimate of damages, but, upon information and belief, said estimate was never provided. Further, the undersigned requested a copy of the Insured’s policy, which State Farm failed to provide, claiming that the policy requested is for the same period that they believe the date of loss to have occurred in, despite knowing that the Insured disagrees with the date of loss that Carrier insists on maintaining despite evidence to support it. The Insured has both a contractual right to the 2022 to 2023 Policy and a statutory right to it under Fla. Stat. 627.351(6)(x)(1)(a) and Fla. Stat. 627.4137(1). The Carrier had a duty to properly investigate the claim, and also to attempt in good faith to settle the claim when acting fairly and honestly toward its insured with due regard to his best interest. And instead of doing so, on a roof claim, they failed to consider a major weather event in the area that would explain the loss to the roof. The Carrier can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy and by paying the Insureds $86,214.85. Further, the Carrier should pay the interest accrued from notice of the claim until the date that the Carrier pays $86,214.85, per Section 627.70131 Florida Statutes.
Comments
User Id Date Added Comment
krothell@flacivillaw.com 03-21-2025 Please allow the following to serve as State Farm Florida Insurance Company’s (“State Farm”) response to the Civil Remedy Notice of Insurer Violations submitted to the Department of Financial Services by you on behalf of your client and State Farm’s insured, Patrick Flood. Mr. Flood alleged that State Farm is in violation of the following sections of the Florida Statutes: 624.155(1)(b)(1); 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b); and 626.9541(1)(i)(3)(d). Without waiving any arguments State Farm has that the Civil Remedy Notice of Insurer Violations is legally insufficient, State Farm specifically denies any wrongdoing in the adjustment and handling of the above-referenced claim. State Farm denies that it committed any acts or violated the provisions of any Florida Statutes, including those referenced in the Civil Remedy Notice of Insurer Violations. Specifically, State Farm advises: • Section 624.155(1)(b)(1), Florida Statutes: State Farm strictly denies any violation of this statute for any and all reasons set forth in this Response to Civil Remedy Notice. • Section 626.9541(1)(i)(3)(a), Florida Statutes: State Farm strictly denies any violation of this statute for any and all reasons set forth in this Response to Civil Remedy Notice. • Section 626.9541(1)(i)(3)(b), Florida Statutes: State Farm strictly denies any violation of this statute for any and all reasons set forth in this Response to Civil Remedy Notice. • Section 626.9541(1)(i)(3)(d), Florida Statutes: State Farm strictly denies any violation of this statute for any and all reasons set forth in this Response to Civil Remedy Notice. The Civil Remedy Notice of Insurer Violations fails to comply with the requirements of section 624.155, Florida Statutes, in that the notice fails to: (1) specifically identify the individuals most responsible for and/or knowledgeable of the alleged violations (rather generally identifying those who handled the claim, despite Mr. Flood and/or his representatives being issued correspondence identifying at least some of the individuals involved in the claim handling); (2) identify and explain with specificity the ways in which the cited statutes were allegedly violated (rather merely listing numerous statutes without application to full and complete claim-specific facts supporting the alleged violations and inconsistently citing additional statutes in the “facts and circumstances” section of the Civil Remedy Notice); (3) identify the specific policy language that is relevant to the alleged violations (rather broadly identifying multiple sections of the policy without application to full and complete claim-specific facts supporting the alleged violations); and (4) provide the specific details to “cure” the alleged violations (other than requesting an unsubstantiated acceptance of “full coverage under the subject insurance policy and by paying the Insureds $86,214.85,” plus unspecified amounts of statutory interest). The Florida Supreme Court has held that the purpose of a Civil Remedy Notice of Insurer Violations is to put the insurer on notice of an alleged violation, the circumstances surrounding the violation, and the details of the violation to provide the insurer with sixty (60) days to “cure” the alleged claim defects. The purpose of the statute is to provide the insurer with an opportunity to resolve first-party coverage disputes and otherwise avoid litigation. See Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000); Lane v. Westfield Ins. Co., 862 So. 2d 774 (Fla. 5th DCA 2003); Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Mr. Flood (through his public adjuster) made a claim to State Farm on September 12, 2024 for damages purportedly occurring approximately four months before on May 18, 2024 (not April 26, 2023). He reported wind and hail damage to the roof, consisting of lifted and creased shingles, as well as water damage to the ceilings in the guest bathroom, laundry room, and office. Thereafter, State Farm received documentation from the public adjuster submitted on behalf of Mr. Flood, including an estimate (which identifies the date of loss is May 18, 2024) for the shingle roof, exterior, guest bathroom, laundry room, and office totaling $90,629.85 (RCV). During an initial telephone conference with Mr. Flood’s public adjuster on September 23, 2024, he advised that there was ceiling and wall damage in the office and ceiling damage in the laundry room. He further advised that both areas of damage were discovered by him during his inspection. A field adjuster then inspected the property on behalf of State Farm regarding the claim on September 30, 2024. Based on the field inspection and its overall claim investigation, State Farm issued a denial letter dated October 15, 2024. State Farm advised that it determined that the condition of the roof was not consistent with damage by wind or hail on the reported date of loss and that there was no evidence of covered accidental damage to the roof or exterior of the house. Rather, the conditions observed included chipped shingles, missing overlay tabs, granular loss, blistering, and discoloration consistent with the age of the roofing system and the effects of exposure to wear, tear, and weather conditions over the life of the roof. Further, State Farm advised that the claimed interior damage was the result of repeated water intrusion from separate roof leaks and wear and tear related failure of exterior weatherproofing that allowed water intrusion on multiple occasions. Because State Farm determined that there was no coverage available under the policy for Mr. Flood’s claimed damages, it did not prepare any estimate of covered damages to provide to Mr. Flood upon request. Thereafter, State Farm received a Sworn Proof of Loss on behalf of Mr. Flood in the amount of the $90,629.85 for a May 18, 2024 date of loss. State Farm acknowledged the Sworn Proof of Loss by letter dated October 21, 2024. Subsequently, State Farm received a Letter of Representation from counsel for Mr. Flood. The Letter of Representation requested that the date of loss be changed to April 26, 2023. State Farm responded by correspondence dated January 15, 2025 advising than an investigation was completed in connection with the date of loss reported, so that the date of loss could not be changed. State Farm further advised that a new claim could be made with the alternate date of loss referenced. Thereafter, State Farm also forwarded a copy of the insurance policy for the reported date of loss by e-mail dated January 21, 2025, not a copy of the prior insurance policy for the alternate date of loss that could not be considered as part of the completed and denied claim but would need to be a separate claim. Mr. Flood also filed a Notice of Intent to Initiate Litigation against State Farm on January 7, 2025. State Farm responded to the Notice of Intent by letter dated January 20, 2025, standing on the denial. Thereafter, Mr. Flood filed the subject Civil Remedy Notice of Insurer Violation against State Farm on January 29, 2025. Subsequently, and during the Civil Remedy Notice cure period, Mr. Flood also filed a lawsuit against State Farm, notably for the alternate date of loss rather than the reported date of loss for this claim. State Farm has made every effort to thoroughly investigate this claim and examine the allegations in the Civil Remedy Notice of Insurer Violations filed by Mr. Flood. State Farm acted appropriately in the adjustment and handling of the above-referenced claim. State Farm specifically denies all allegations of non-compliance with Florida Statutes. The Civil Remedy Notice of Insurer Violations does not constitute sufficient notice to State Farm of any acts or omissions that substantiate the allegation that State Farm has violated any statutes applicable to the loss. Furthermore, the Civil Remedy Notice of Insurer Violations is totally deficient with respect to the specific requirements of section 624.155, Florida Statutes. Based on its good faith investigation of the subject insurance claim, State Farm is unable to offer any cure of the Civil Remedy Notice of Insurer Violations at this time. There is presently no coverage/recovery available under the policy for Mr. Flood’s claimed damages. Consequently, no payment whatsoever is due to Mr. Flood at this time. In conclusion, State Farm Florida Insurance Company has evaluated this claim in good faith and all allegations of violation are statutorily deficient and without merit. I trust that the foregoing, without waiver of arguments regarding the lack of validity of the Civil Remedy Notice of Insurer Violations, adequately addresses any concerns that you and your client may have regarding this matter.
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