Civil Remedy Notice of Insurer Violations
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Filing Number:     804603
Filing Accepted:  1/31/2025
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Complainant
Last/Business Name *  
BELKIS NIVAR AND CARLOS FERNANDEZ   First Name  
Street Address * 16950 SW 145TH COURT
City, State Zip * MIAMI, FL 33177
Email Address * CARFERNANDEZ1@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BELKIS NIVAR AND CARLOS FERNANDEZ   First Name  
Policy # * PFL 333749-01 Claim #* CFL18546521
Attorney
Attorney is Applicable
Last Name* BORSHCHUKOV First Name * VYACHESLAV Initial
Street Address* 514 SE 11TH COURT
City, State Zip* FORT LAUDERDAL , FLORIDA 33316
Email Address * SERVICE@VB.LEGAL
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):* PEOPLE'S TRUST INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
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.
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* 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 that should be relevant to the violations alleged includes, but is not limited to: 1) those related to the dwelling damages, 2) those related to any potential, incurred additional living expenses during periods of repair, 3) those related to the insurer's duty to acknowledge the loss and/or claim, 4) those related to the insurer’s duty to adjust the loss and/or claim, 5) those related to the insurer’s duty to act on and timely pay claims, 6) those related to "all risk" coverage. 7) those related specifically to water damage, 8) those related specifically to mold damage Also, 1) coverage A provisions, 2) coverage D provisions, 3) the "duties after loss" provisions, 4) the "loss settlement" clause, 5) the "loss payment" section, as well as 6) other portions of the "conditions" portion of the policy generally, and 7) any other contractual provisions that are or appear relevant based on a reasonable reading of the following explanation of the "facts and circumstances". And, 1) “Property coverages” section of the policy, 2) “Perils insured against” section of the policy, 3) “Exclusions” section of the policy 4) “Conditions” section of the policy, 5) “Special conditions – Florida” section of the policy, As well as the policy's Preferred Contractor Endorsement .
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This notice stems from the Insurer's failure to cover and pay the full amount of proceeds due to the Insureds as a result of property damage stemming from a Hurricane Irma loss causing sudden and immediate physical damage to the insured property with a date of loss of September 10, 2017. The Insurer failed to adequately adjust and pay the claim covered under the subject insurance policy pursuant to its Best Claims Practices, and the Policy’s Loss Settlement and Loss Payment provisions. Specifically, the Insured elected to participate in the Preferred Contractor Endorsement program, wherein the Insurer would hire a contractor directly to perform the repairs to the property related to the loss. After adjustment of the claim, the Insurer afforded coverage for the reported loss. Thereafter, the Insured elected to participate in the carrier’s Preferred Contractor Endorsement Program. The Insureds cooperated with the carrier in compliances with the requirements of the Preferred Contractor Endorsement. The Insurer contracted with their own vendors to perform the repairs under the Preferred Contractor Endorsement. The repairs performed by the Insurers’ contractors were subpar and/or insufficient to bring the property to its’ pre-loss condition. Upon multiple attempts by the Insureds to have the carrier correct these issues, the Insurer continued to stonewall the Insureds, refusing to correct or pay for proper repairs to the property related to the covered loss. The Insurer refused to fix the improper and insufficient work performed by their own vendor. As to 626.9541-1-i-3-c: The carrier failed to acknowledge and act promptly upon receiving the correspondence from the Insured with regard to the unsatisfactory nature of the repairs made and work completed by the Insurer’s contracted vendors. As to 626.9541-1-i-3-g: The carrier failed to acknowledge and act promptly upon receiving the correspondence from the Insured with regard to the unsatisfactory nature of the repairs made and work completed by the Insurer’s contracted vendors. Further, the insured believes additional factual basis for these violations will come to light during the course of litigation during the initial lawsuit and bad faith lawsuit. It is believed that additional facts related to these and additional violations of Florida Statute 626.9541 will come to light during the litigation/trial related to this matter, as well as the subsequent bad faith lawsuit. Further, as to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insureds claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered in the future. It is believed that the Insurer shops findings, such a cause and origin, as a general business practice to write reports which support claim denials. Against this backdrop, it would have been prudent for the Insurer to allow the insureds to have some input in the selection of an engineer. However, the Insurer did not do so and it is likely, when the Insurer eventually issues its findings, a denial will most probably mirror the exclusions found in the insureds contract. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has reached this duty in the adjustment of this loss. The Insurer was late in raising, or failed to raise, its adjustment reserves as per Florida law and/or the Insurer's own policy on expense reserving. The Insurer has failed to create and implement its own guidelines for proper investigation of claims handling and for training and supervision of employees and representatives which have resulted in some of the statutory violations set forth above. The Insurer charged a substantial premium for these coverages but has refused to tender any payment when under all circumstances it could have and should have done so had it acted fairly and honestly. Additionally, it appears this is done company-wide. This forced the Insured to seek professional services to protect the interests of the Insured. The Insurer’s wrongful conduct and omissions include, but are not limited to, the following: 1. claim delay; 2. not conducting full and prompt investigation; 3. not treating the policyholder with good faith claims conduct; 4. refusing to assist in obtaining temporary housing; 5. looking for ways to deny, reduce, or delay full recovery to Insured; 6. holding back and failing to pay portions of claim clearly owed; 7. not adjusting the claim and evaluating the loss properly, and not promptly and fairly providing full and prompt indemnity to the insured; 8. failing to implement proper standards for the adjustment and investigation of claims; 9. 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; 10. establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; 11. failing to pay the full amount of the Insureds damage despite knowing it must do so; 12. failing to timely notify the Insured of their right to mediate their claim pursuant to F.S. section 627.7015. There may be further wrongful conduct which has not been made known to the Insureds. Certain conduct or actions cannot be verified without a review of The Insurer s claims file and claim guidelines. Therefore, to cure the defects outlined in this Civil Remedy Notice, The Insurer must: 1. Immediately tender all insurance monies due to the Insureds for the loss as submitted; 2. Act fairly and honestly towards the Insureds and with due regard for their interests in attempting to settle the claim; 3. Pay statutory interest on the amount of unpaid contractual damages from the date the claim was reported; 4. Pay attorney fees in the amount determine by the Court; 5. Cease and desist all present and future bad faith actions with regard to the Insureds claim. Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Comments
User Id Date Added Comment
justin@sdtriallaw.com 04-01-2025 On January 31, 2025, People’s Trust Insurance Company received a Civil Remedy Notice (“CRN”) regarding the above claim and/or policy. We appreciate the opportunity to respond and address all the allegations raised by the Complainants, Belkis Nivar and Carlos Fernandez. People’s Trust Insurance hereby denies each and every alleged statutory violation (Fla. Stat. §§ 624.155, including all subparts). People’s Trust Insurance Company also denies any violation of any other applicable insurance statute, administrative code, or any provision of the homeowners’ insurance policy issued to Belkis Nivar and Carlos Fernandez. Moreover, since the filing of the Civil Remedy Notice, People’s Trust Insurance Company has entered into a settlement agreement and release with Complainants on February 24, 2025 to resolve all claims associated with Claim No. CFL18546521. As a result, the Civil Remedy Notice has been cured and Complainants have released People’s Trust Insurance Company from any and all alleged statutory violations and/or extra-contractual claims set forth in CRN 804603. Moreover, pursuant to the release and settlement of this claim, People’s Trust Insurance Company maintains it denial as to the allegations set forth herein. (submitted by Justin N. Rost, Esq of St. Denis & Davey, PA, Counsel for People’s Trust)
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