Civil Remedy Notice of Insurer Violations
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Filing Number:     804276
Filing Accepted:  1/30/2025
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Complainant
Last/Business Name *  
PAUL TRUONG & QUYEN DIEP   First Name  
Street Address * 5724 TROUT BAYOU CIR
City, State Zip * MILTON, FL 32583
Email Address * ITA@LRLC.LEGAL
Complainant Type: * Insured
Insured
Last/Business Name*   PAUL TRUONG & QUYEN DIEP   First Name   ITA
Policy # * FLB0001201 Claim #* 1124000063
Attorney
Attorney is Applicable
Last Name* FRASER First Name * ITA Initial
Street Address* 16375 NE 18TH AVE
City, State Zip* MIAMI , FL 33162
Email Address * ITA@LRLC.LEGAL
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   US COASTAL PROPERTY & CASUALTY INSURANCE COMPANY
NAIC Company Code 15900
 
Name of individual responsible for violation (if any):* LAMARTINEZ WALKER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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)(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.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

“Matching Sublimit Policy Endorsement CHO 500 05 22” Section 8(d)(1), which states: “We insure for direct physical loss to covered property involving abrupt collapse of a building or any part of a building if such collapse was caused by one or more of the following: (1) The Perils Insured Against in Coverage A.” "The amount in dispute must be between $500 and $25,000 notwithstanding of any applicable deductible, unless both parties agree to appraisal of a claim involving a disputed amount of less than $500 or more than $25,000."
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Count 1: Misuse and Misrepresentation of Policy Language On or about February 15, 2024, the carrier issued a payment letter quoting policy language under the “Matching Sublimit Policy Endorsement CHO 500 05 22” as a basis for their gross underpayment of the loss. The carrier misused the policy language by: 1. Misclassifying items related to the claim. 2. Ignoring basic reconstruction methodology. 3. Failing to comply with applicable law and ordinance requirements for repairs, including necessary permits. 4. Disregarding industry standards for reconstruction. This constitutes a gross misrepresentation of the policy, demonstrates faulty business practices, and reflects a failure to act in good faith when adjusting the claim. Count 2: Failure to negotiate in good faith The carrier invoked a $10,000 sublimit for water damage under the policy. However, this decision ignored specific policy language, notably Section 8(d)(1), which states: “We insure for direct physical loss to covered property involving abrupt collapse of a building or any part of a building if such collapse was caused by one or more of the following: (1) The Perils Insured Against in Coverage A.” Despite this, the carrier’s payment letter dates February 15, 2024 erroneously stated: “The total limit of liability for water damage to property covered under Section - Property Coverages is $10,000 per occurrence”. This was a clear misrepresentation of the policy terms. The loss, triggered by the failure of a supply line in the ceiling, resulted in a collapse that should not have been limited to the water damage sublimit. The Proof of Loss submitted on October 15, 2024 clearly states the type of damage as “collapse”, not water. Page 3 of the carrier’s payment letter further confirms that: “If an ensuing loss to covered property by a peril insured against results from the loss as described in this endorsement, the limited water damage coverage limit does not apply to that covered peril loss”. The carrier ignored this provision by improperly classifying the loss solely as water damage and not a collapse, contrary to the evidence provided, including the Proof of Loss that identified the collapse as the triggering peril. Count 3: Claim Delay and Bad Faith in Denying Appraisal Despite attempts to settle the claim through a fair appraisal process, the carrier rejected the public adjuster’s (Jenna Rhyne) demand for appraisal, citing policy language that limits the appraisal process to disputes of $25,000 or less. This delay constitutes bad faith as the carrier: 1. Forced the insured to lower their damages to meet the $25,000 threshold. 2. Prolonged the resolution of the claim unnecessarily. The enforcement of this policy provision demonstrates an intentional attempt to coerce the insured into accepting a reduced settlement amount or pursue litigation instead of allowing a fair appraisal process. This provision within itself discriminates against insureds with losses exceeding $25,000 and violates the carrier’s duty to act fairly and in good faith toward its policyholders. Furthermore, Carrier submitted a response letter to the Proof of Loss which stated: “US Coastal Property & Casualty Insurance Company position set out above is based upon the information we have to date. If you feel we are not in possession of all the facts or should you have any other information that you would like for US Coastal Property & Casualty Insurance Company to consider or that you feel would affect US Coastal Property & Casualty Insurance Company coverage investigation and subsequent coverage decision in this matter, please do not hesitate to send that information directly to us as soon as possible. We will be happy to review the information and re-evaluate the decision in this matter as necessary.” This response indicated that the carrier would be willing to re-inspect the property which could have been done through the process of appraisal and or a simple re-inspection. Neither of those things happened. Instead, the carrier stood by an unfounded decision and hid behind policy provisions that are not applicable in this case. To cure the violations outlines above, the carrier must: -Immediately withdraw any improper limitations of damages applied to this loss and fully comply with all terms and conditions of the policy. -Identify and apply the proper Peril Insured Against as set forth in the policy, ensuring an accurate and fair assessment of the covered loss. -Immediately agree to appraisal for the entirety of the loss without further delay to allow an independent and impartial evaluation of the dmages.
Comments
User Id Date Added Comment
dwinningham@bressler.com 03-20-2025 Via E-Mail & Certified Mail Return Receipt Requested: ita@lrlc.legal Paul Truong & Quyen Diep c/o Ita Fraser, Esq. Litigation & Recovery Law Center, P.I. 16375 NE 18th Ave., Suite 321 N. Miami Beach, FL 33162 Re: Insured(s) : Paul Truong & Quyen Diep Complainant(s) : Paul Truong & Quyen Diep Policy # : FLB0001201 Claim # : 1124000063 DFS Filing # : 804276 To Whom It May Concern: We write on behalf of US Coastal Property & Casualty Insurance Company (“US Coastal”) to respond to the Civil Remedy Notice of Insurer Violations (hereafter “CRN”) submitted to the Department of Financial Services (hereafter “DFS”) on behalf of Paul Truong and Quyen Diep (hereafter “Complainants”) and identified as Notice No. 804276. The Insureds identified in the Notice are Paul Truong and Quyen Diep. The DFS accepted the Civil Remedy Notice on January 30, 2025. The CRN alleges US Coastal violated the following statutory provisions: 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)(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. 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. Simply stated, US Coastal denies any act or omission that could be construed or found to be deemed bad faith and/or a violation of Florida Statutes §626.155 and § 626.9541, whether expressly stated in the CRN or implied. Any and all allegations of bad faith are hereby denied and rejected in their entirety by US Coastal. US Coastal denies and rejects the instant CRN as it fails to comply with the requirements of Fla. Stat. § 624.155. Specifically, the subject CRN is non-compliant with the form requirements set forth in Florida Statute § 624.155, which requires a complainant file with the Department of Financial Services a CRN which shall be “on a form provided by the [Department] and shall state with specificity…such other information as the Department may require.” The Department created a CRN form: Form DFS-10-363 which lays out 15 requirements, including in part, the Complainants E-mail address, Complainant Type, Attorney’s Name, Attorney’s Address, Attorney’s Email Address, Type of Insurer, Address of Insurer, Type of Insurance, Reason for Notice. Complainants failed to provide their email address as required, but instead lists the email address of their attorney. Based on this failure alone, the CRN must be rejected for facial invalidity. We further note the following defects, both “technical” and substantive, with the CRN. First, the CRN purports to reference various policy provisions relevant to the alleged statutory violations. However, review of each of the cited provisions reveals that the referenced sections are incomplete, purposefully limited to obscure the true nature of the policy provision, and/or are inapplicable to the reported claim. Therefore, it is impossible for US Coastal to have allegedly violated such provisions. Moreover, there isn’t a single fact, act, or omission cited in the Notice to support US Coastal’s alleged violation of these incorrect policy provisions. Accordingly, it is simply not possible for US Coastal to ascertain what specific policy language the Complainant contends to be applicable or how any such policy language bears any relevance or relation to the wrongful conduct alleged. This is direct and clear noncompliance with the requirements of Fla. Stat. § 624.155. Therefore, failure to include specific, applicable policy language renders the CRN deficient on its face, as to form and substance. Second, the CRN further fails to comply with the requirements of Fla. Stat. §624.155. Specifically, Fla. Stat. §624.155(3) requires that a civil remedy notice of insurer violation “state with specificity,” inter alia, the facts, and circumstances giving rise to the violation and the “specific” language of the subject insurance policy that is relevant to the violation. The Complainants wholly fails to provide any specific facts or circumstances giving rise to the alleged violations in the CRN, and instead simply alleges inaccurate and misconstrued facts as well as non-specific, conclusory, and unsupported allegations against US Coastal. Furthermore, the Complainant fails to cite any actions that would be indicative of bad faith and mischaracterize the subject policy as well as the statutory regulations governing the handling and adjustment of an insurance claim. The CRN filed on behalf of the Complainants fails to set forth any specific acts, facts, or circumstances, which would give rise to the claimed statutory violations, thus preventing US Coastal from providing any meaningful or complete response thereto. In particular, the CRN does not provide any factual support specific to the subject insurance claim with regard to the alleged statutory violations identified above, nor is there any mention in the CRN as to how the few “facts” stated in the CRN may even be applicable to the statutory violations alleged. What the CRN makes clear is that the Complainants do not like the clear and unambiguous terms of the Policy they purchased from US Coastal. Notwithstanding the forgoing, the actual facts of this claim reveal that no violation has occurred. On January 25, 2024, a claim for water damage to the Insureds’ property was opened, with that same day noted as the date of loss. The initial claim report noted the following: “Cause: Water. Description of Accident/Damage: Pipe Damage: Attic leakage harmed bedroom, laundry drywall, ceilings stained, walls discolored.” The claim was indisputably reported as a claim for water damage resulting from a busted or damaged pipe. On February 15, 2024, following an initial inspection, US Coastal issued its initial coverage determination letter, noting that the inspection revealed ensuing water damage to the laundry room and bedroom closet as a result of a failed supply line in the attic. The letter explained that US Coastal was issuing payment for the ensuing water damage totaling $3,593.01 (net payment minus $1,000 deductible) based on an estimate of $4,278.19 in dwelling replacement cost and $341.82 for matching undamaged property. The letter also indicated that the damage to the actual plumbing system itself was not covered under the policy as such damage was found to be the result of wear, tear, and deterioration and/or inherent vice, latent defect, or mechanical breakdown. The letter included relevant excerpts from the policy to support the coverage determination, including the policy’s limited water damage coverage endorsement providing $10,000 per occurrence (absent this endorsement, the policy would have no coverage for water damage per another policy endorsement that Complainants selected when purchasing their policy). The letter invited Insureds to submit additional documentation or supplemental claims should they discover additional damage or complete repairs. US Coastal sent a copy of the estimate along with the letter. In the days that followed, Complainants sent several emails to the adjuster disputing coverage, claiming they were owed $7,514 for plumbing and $5,400 in repairs, totaling $12,914. On March 4, 2024, US Coastal responded by reiterating that Complainant’s policy did not cover the damage to the plumbing and that an itemized estimate would be needed to support any further claim for repairs. Insureds eventually sent estimates obtained from their preferred contractors to support their demand for $12,914. For several months, Complainants and US Coastal exchanged emails discussing coverage and a re-issuance of the initial payment, which Complainants claimed to not have received. As shown in the email correspondence, Complainants provided a new mailing address after the original check was issued. This was after they demonstrated an inability to access the direct deposit payment option provided by US Coastal. Insureds confirmed receipt of the initial payment on June 25, 2024. Complainants retained a public adjuster on March 26, 2024. Thereafter, Complainants public adjuster wrote to US Coastal claiming that she was preparing an estimate for the Insureds’ claim, that it was already in excess of the policy’s $10,000 limit for water damage, and asking how much it would take to settle in exchange for a release. In response, US Coastal requested a copy of the estimate and was told that it was in progress. In July, August, and September, US Coastal sent multiple emails reiterating its request for the estimate prepared by the public adjuster. Again, Complainants had previously submitted estimates from their preferred contractors for full repairs to both the plumbing system and water damaged areas in the amount of $12,914. Nonetheless, on October 15, 2024, Complainants’ public finally submitted an estimate for $104,276.15, including a blanket $25,000 amount for “MOLD ALLOWANCE”, $17,304.71 for “water damage repairs” (even though that’s what the rest of the estimate allegedly represents), $9,437 for permits and fees, and $19,720 for loss of use (despite there being no evidence whatsoever that the property was uninhabitable). The basis for Complainants’ claim for $104,276.15 in damages is unclear and goes unmentioned in the Civil Remedy Notice. Complainants also executed and submitted a Sworn Proof of Loss seeking $99,952.09, despite previously submitting contractor estimates for completion of all of the repairs resulting from the damage amounting to $12,914. US Coastal has fulfilled its obligations under the Policy. US Coastal performed an investigation and issued a prompt replacement cost value payment pursuant to the terms, exclusions, and conditions of the Policy. US Coastal further invited Complainants to submit additional documentation and/or a supplemental claim to US Coastal in the event that additional damage was discovered during the course of repairs or if the repairs exceeded the amount paid by US Coastal. Complainants never submitted documentation indicating that they have completed any repairs to the damaged dwelling. Therefore, no further payments are due and owing under the Policy. As for the “Counts” alleged in the CRN, Complainants allegations lack any basis. US Coastal has not misrepresented any policy language. It quoted all of the language related to its coverage determination, including the provision related to the repair of undamaged property, which includes a limitation for such repairs. There was no misrepresentation and Complainants do not identify any misrepresentation by US Coastal. Furthermore, Complainants’ attempt to mischaracterize the loss as a “collapse” as oppose to a loss resulting from water is laughable. The claim was reported as a water loss from a damaged plumbing pipe. The “collapse” was undisputably caused by water, which places it squarely within the limited water damage coverage endorsement set forth in the Policy and in US Coastal’s correspondence. Finally, the argument regarding appraisal amounts to nothing more than a complaint about the language of the Policy Complainant’s bargained for. There is no claim delay, misrepresentation, or bad faith on the part of US Coastal. Finally, the “cure” proposed in this particular CRN is deficient, as it fails to provide a clear and ascertainable monetary demand to that would cure the alleged violations. Instead, the CRN states that US Coastal may cure by: -Immediately withdraw any improper limitations of damages applied to this loss and fully comply with all terms and conditions of the policy. -Identify and apply the property Peril Insured Against as set forth in the policy, ensuring an accurate and fair assessment of the covered loss. -Immediately agree to appraisal for the entirety of the loss without further delay to allow an independent and impartial evaluation of the damages. The Insured’s cure demand is unquestionably unascertainable by US Coastal. For example, the cure demands that US Coastal “withdraw any improper limitations of damages applied to this loss,” but US Coastal has applied the Policy pursuant to its terms and conditions as set forth above. Who determines what limitations are “improper?” Likewise, US Coastal has identified and applied the correct Policy provisions to this loss, which was reported by Complainants as a water loss caused by a plumbing leak. It is the very definition of a water loss and, therefore, US Coastal applied the limited water damage endorsement negotiated for by the Complainants themselves. Finally, the demand for appraisal in the cure goes directly against the terms and conditions of the Policy. A cure demand in a civil remedy notice should be demanding that a carrier abide by the terms of the subject policy, not act in contravention of them, which is what this cure demand appears to be doing. Regardless, the cure demand contained in the CRN falls woefully short of the clear and ascertainable monetary demand contemplated by the statue and is invalid on its face. To the extent that this response does not address each and every allegation of bad faith conduct made by the Insured, US Coastal hereby expressly and vehemently denies any and all allegations of bad faith conduct or omission set forth in the CRN, and/or any alleged violation of Fla. Stat. § 624.155 and 626.954 or any other statutory sections set forth therein. Again, US Coastal insists that it has acted, at all times, in utmost good faith. Should you need any additional information from US Coastal regarding the foregoing, please feel free to contact the undersigned. In short, and contrary to the unsupported statements contained in the CRN, the facts of this case are that US Coastal performed its duties and has further complied with applicable Florida law and did not at any time whatsoever act in bad faith towards the Insured in the handling of the subject claim. If we can provide any additional information, or be of any further assistance, please do not hesitate to contact me at your earliest convenience. Very truly yours, /s/ Donald F. Winningham III Donald F. Winningham III, 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.

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