Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 804542

Filing Accepted: 1/31/2025

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Complainant

Last/Business Name *

(JENTZSCH) JOHNSON

First Name

MICHELLE

Street Address *

3301 WEST SAN PEDRO STREET

City, State Zip *

TAMPA, FL 33629

Email Address *

SHELLYLYNN711@MSN.COM

Complainant Type: *

Insured

Last/Business Name*		(JENTZSCH) JOHNSON		First Name		MICHELLE
Policy # *		HCPC-HO3-479376-6		Claim #*		9210923

Attorney

Attorney is Applicable

Last Name*	KRAPF First Name * GRANT Initial W
Street Address*		2790 SUNSET POINT RD
City, State Zip*		CLEARWATER , FL 33759
Email Address *		GRANT@KRAPFLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

Name of individual responsible for violation (if any):* ROSILAND GARDNER, MICHAEL TAYLOR, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY OR GRISTON CLAIMS WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Unfair Trade Practice
	Other : not treating the policyholder with good faith claims conduct
	Other : not adjusting claims and evaluating loss properly
	Other : failing to implement proper standards for the adjustment and investigation of claims
	Other : looking for ways to delay full recovery to the Insured
	Other : not training, supervising, or managing adjusters properly so that prompt and full payments are made
	Other : conducting inadequate investigations
	Other : making material misrepresentations
	Other : shifting the burden of investigating the loss onto the Insured

* 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)(2)		A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
	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.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Homeowners Choice Property & Casualty Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of insurer before that of the Policy Holder and Insured; 3) looking for ways to deny benefit payments and otherwise "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) looking for ways to delay benefit payments; 7) conducting inadequate investigations; 8) failing to render a claims determination within ninety days; and 9) failing to provide a loss run statement. On or about September 28, 2022, while the subject policy was in full force and effect, the Insured's home was damaged by Hurricane Ian. The Insured submitted a claim to the Insurer for damaged areas which include, but are not limited to, the roof, dining room, laundry room, and kitchen. The Insurer then assigned claim number 9210923 to the loss and sent a field adjuster to inspect the insured property on January 12, 2023. In a letter dated February 2, 2023, the Insurer wrongfully denied the Insured's claim, and incorrectly stated the claim was for a generator, despite the Insured never reporting a broken generator. In addition to citing the wrong cause, the Insurer's letter failed to provide any factual basis for denying the claim. Given the scope and nature of the damage resulting from Hurricane Ian, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $52,755.96 in covered damage. The foregoing estimate, photographs, and a letter of representation were sent to the Insurer. By failing to conduct an adequate investigation, the Insurer has shifted the burden of investigating the loss onto the Insured. To date, the Insured has incurred at least $1,533.39 in water mitigation costs and at least $11,229.55 in mold remediation costs. The Insurer has placed its financial interests above the health and safety of the Insured, Further, The Insurer's wrongful denial and delay has caused the Insured to lose rental income from the insured property. The Insured's tenant was unable to move in to the property, as the Insured was unable to repair the extensive damages due to the Insurer's wrongful denial. The Insured has lost at least $12,000.00 in rental income due to the Insurer's wrongful denial and refusal to pay what is owed under the policy of insurance. Given the scope and nature of the damages resulting from Hurricane Ian, the Insured retained a roofing contractor who prepared an estimate, dated December 15, 2022, detailing $96,475.30 in covered damages to the Insured's home. Further, upon the Insured's investigation, the true cost to replace the motorized shades is more than double what the Insurer estimated. It is clear the Insurer is not conducting adequate research to provide Insureds with the realistic and accurate funds to return properties to their pre-loss conditions. Despite being hit by a hurricane, the Insurer incorrectly determined that the damage to the Insured's roof was a result of "wear, tear, and deterioration." The Insurer is refusing to pay for a full re-roof (and any roof-related damage) despite knowing it is obligated to do so. Florida Building Code section 708.1.1 states that not more than 25% of the total roof area or roof section of any existing building or structure shall be repaired, replaced or recovered in any 12-month period unless the entire roofing system or roof section conforms to the requirements of this code. The aforementioned circumstances require that the Insurer replace the roof, yet the Insurer has refused to do so. Pursuant to Florida Statute 627.7011(b), Insurers have a duty to cover all costs necessary to meet applicable laws and ordinances regulating the repair of any property. Further, Florida Statute 626.9744 requires that the Insurer make reasonable repairs or replacement that match the quality, color or size of the items that need repair. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured's claim. The Insurer's actions amount to but are not limited to the following: 1. Not treating the policyholder with good faith claims conduct 2. Shifting the burden of investigating the loss onto the Insured 3. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 4. Failing to implement proper standards for the adjustment and investigation of claims 5. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the policyholder's interests 6. Conducting inadequate investigations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1) Admit full coverage for the Insured's loss. (2) Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: Homeowners Choice Property & Casualty Insurance Company P.O. Box 22967 Tampa, FL 33622 claims@hcpci.com

Comments

User Id		Date Added		Comment
Legal@hcpci.com		04-01-2025		This is Homeowners Choice Property & Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Grant Krapf, Esq. on behalf of Michelle (Jentzsch) Johnson (“Insured”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Under the relevant facts and circumstances, the applicable insurance contract did not provide coverage for the claim. Ultimately, HCPCI handled the claim in accordance with the policy and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Otherwise, the CRN is deficient. Generally, pursuant to Florida Statutes, Section 624.155, CRNs must identify and set forth statutory provisions insurers allegedly violated in handling insureds’ insurance claims along with specific, relevant insurance contract language and facts and circumstances. The foregoing provides insurers with notice of alleged statutory violations AND the opportunity to cure such alleged violations. Instead of complying with Florida Statutes, Section 624.155, the Insured’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; and relied on inaccurate and conclusory statements. The Insured’s laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, the Insured’s attorney filed a lawsuit based on the claim prior to the filing of this CRN. Regardless of the fact there were no violations in this case, any action by HCPCI to cure violations alleged in the CRN could have been used against HCPCI in the lawsuit. The foregoing shows abuse by the Insured and the Insured’s attorney of the CRN and legal processes. Also and generally, the CRN constitutes an abuse of the CRN process, contravenes the purpose of CRNs, which is to promote resolution of issues in insurance claims. The CRN must be rejected, and it cannot serve as the basis of any action against HCPCI. Upon request by the Florida Department of Financial Services, HCPCI will provide to the DFS detailed correspondence HCPCI provided regarding the claim.

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