Civil Remedy Notice of Insurer Violations
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Filing Number:     804929
Filing Accepted:  2/4/2025
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Complainant
Last/Business Name *  
TRAYER   First Name   ALEXEY AND ANNA
Street Address * 15510 MARTINMEADOW DRIVE
City, State Zip * LITHIA, FL 33547
Email Address * CFAUNTLEROY@FSATLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   TRAYER   First Name   ALEXEY AND ANNA
Policy # * 80-EH-U860-9 Claim #* 59-75H3-60R
Attorney
Attorney is Applicable
Last Name* FAUNTLEROY First Name * CHRISTOPHER Initial B
Street Address* 100 S ASHLEY DRIVE, SUITE 600
City, State Zip* TAMPA , FLORIDA 33602
Email Address * CFAUNTLEROY@FSATLAW.COM
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):* STORM DUERFELDT AND STATE FARM AND ITS ADJUSTERS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
Claim Delay
* 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)(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.
* Specific policy language that is relevant to the violation.
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Specific policy language that is relevant to violation: . SECTION I – PROPERTY COVERAGES COVERAGE A – DWELLING 1. Dwelling. We cover the dwelling and materials and supplies located on or adjacent to the residence premises for use in the construction, alteration, or repair of the dwelling or other structures on the residence premises. Loss Payment Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable upon the earlier of the following: reach agreement with you; or b. 60 days after we receive your proof of loss and: (1) there is an entry of a final judgment; or (2) there is a filing of an appraisal award with us. If we do not pay or deny a loss within 90 days after we receive notice of an initial, reopened, or supplemental property insurance claim from you and no factors beyond our control would reasonably prevent us from making payment, interest will be paid in accordance with Section 627.70131(5) of the Florida Insurance Code. Loss Settlement COVERAGE A – DWELLING 1. A1 – Replacement Cost Loss Settlement – Similar Construction. a. We will pay the cost to repair or replace with similar construction and for the same use on the premises shown in the Declarations, the damaged part of the property covered under SECTION I – PROPERTY COVERAGES, COVERAGE A – DWELLING, except for wood fences, subject to the following: (1) we will pay only the actual cash value at the time of the loss prior to repair or replacement of the damaged part of the property, up to the applicable limit of liability shown in the Declarations, not to exceed the cost to repair or replace the damaged part of the property; (2) in addition, we will pay any remaining covered additional amounts you actually and necessarily incur to perform such repair or replacement as work is performed and expenses are incurred and submitted, or an amount up to the applicable limit of liability shown in the Declarations, whichever is less. There will be no deduction for depreciation; ***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:*** §624.155(1)(B)(1) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 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 towards its insured and with due regard for her interests; 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or 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. §624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (a) Willful, wanton, and malicious; (b) In reckless disregard for the rights of any insured; or (c) In reckless disregard for the rights of a beneficiaries under a life insurance contract; (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. §627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. (4) For purposes of this section, the term “insurer” means any residential property insurer. §626.9541(i) Unfair Claim Settlement Practices
 
* Facts and circumstances giving rise to the violation.
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In Florida, the work of adjusting insurance claims engages the public trust. State Farm Florida Insurance Company (State Farm) has breached this duty in the adjustment of Alexey Trayer’s and Anna Trayer’s (the Trayers’) claim. State Farm has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice. Furthermore, State Farm has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices. The Trayers’ claim results from hurricane loss and wind damage to their home that occurred on October 9, 2024. To mitigate the damages to their home, the Trayers contacted their insurance company, State Farm, to report the damages. As part of the investigation of the Trayers’ claim, State Farm assigned a claim number 59-75H3-60R and independent adjuster Storm Duerfeldt. State Farm inspected the damages to the Trayers’ property. Subsequently, State Farm partially denied the Trayers’ claim, stating that the loss is less than the $16,140.00 deductible. In view of the foregoing, it is clear and unequivocal that State Farm has failed to provide proper and sufficient compensation to repair the damages caused to the Trayers’ property. Due to State Farm’s handling of the Trayers’ claim, the Trayers chose to retain a public adjuster to further assess the damages to their home. As such, upon inspection and view of the damages, it was clear that the dwelling roof, interior, and exterior of the property required extensive repair. After the inspection, the public adjuster provided an estimate for repairs in the amount of $184,909.45, which is the full amount to return Trayers’ home back to pre-loss condition. State Farm continues to hold their stance for their claim determination concerning the Trayers’ loss. The Trayers have complied with all conditions under the policy. Nonetheless, State Farm failed to properly compensate the Stewarts for their loss. The facts of this claim show that for whatever reason, State Farm not only substantially misinterpreted the scope of damages to the Trayers’ property, but also failed to conduct a thorough investigation as to the scope of damages to the roof, interior, and exterior of their home. Upon view of State Farm’s claims handling procedures, it is clear State Farm conducted a limited and quick outcome orientated investigation in the hopes that the Stewarts would make the required repairs with their own money. The Trayers now must incur costs for assistance to obtain what should have been paid had they been treated fairly and honestly by State Farm. Florida Statute §626.9744(2) provides that “When a loss requires replacement of items and the replaced items do not match in quality color or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas”. In the instance of State Farm, their adjusters and the estimate provided, it is clear that State Farm did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of the Trayers’ home as well as the surrounding areas that would need to be replaced. Florida Statute §624.02, defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or a determinable benefit, upon determinable contingencies – inherent is the fact that payment must be made timely and promptly. The fact that payment must be made timely and promptly so that the insureds may mitigate their damages, and to put the insureds back into the position they enjoyed prior to the loss as quickly as possible. State Farm has breached this duty by improperly investigating the Trayers’ claim and failing to properly pay the Trayers for their loss. State Farm has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards the Trayers. In view of the facts surrounding the Trayers’ claim, it is evident that State Farm has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, State Farm has failed and/or refused to investigate the insureds’ claim thoroughly, accurately, and completely for damages. Furthermore, State Farm has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service, and indemnity, has failed to conduct a full and fair investigation of the claim. Florida Statutes Violated by State Farm are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined. § 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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 investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims. Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. State Farm can cure this default by the following: A. Create, adopt, and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims. B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future. C. Tender payment to the Trayers in the amount of $184,909.45, which is the amount to return the Trayers’ home back to pre-loss condition. D. Tender prejudgment interest from the date the claim was reported through today. E. Agree to pay the Trayers’ reasonable attorney’s fees pursuant to Florida Statute §627.428 and all taxable costs
Comments
User Id Date Added Comment
edelcroix@kelleykronenberg.com 03-14-2025 March 14th, 2025 Via Electronic Submission Alexey and Anna Trayer c/o Christpher B. Fauntleroy 100 S Ashley Drive, Suite 600 Tampa, FL 33602 RE: FORMAL RESPONSE TO CIVIL REMEDY NOTICE # 804929 Complainant: Alexey and Anna Trayer Claim No.: 59-75H3-60R Policy No.: 80-EH-U860-9 Date of Loss: October 9, 2024 – Hurricane Milton Address: 15510 Martinmeadow Drive, Lithia, FL 33547 CRN No: 804929 CRN Filing Date: February 4, 2025 To Whom it May Concern, This is State Farm Florida Insurance Company’s (“State Farm”) formal response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Alexey and Anna Trayer by attorney Christopher Fauntleroy, Esq., as it relates to Claim number 59-75H3-60R. The Department of Financial Services (“DFS”) accepted the CRN on February 4, 2025, and assigned it filing number 804929. The following reply has been uploaded to the Department of Financial Services. After reviewing the CRN, State Farm denies all allegation contained in the Insureds’ CRN. State Farm conducted a thorough review of its handling of the Insureds’ claim, Subject Claim No.: 59-75H3-60R. State Farm denies that it has violated any of the statutes as alleged in the CRN. At all times, State Farm acted in good faith, fairly and honestly toward its Insured and with due regard for the Insureds’ interests. State Farm also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information to allow State Farm to correct the alleged violations. The CRN requires the Insureds to “indicate all statutory provisions alleged to have been violated," pursuant to section 624.155, F.S. The notice filed by Christopher Fauntleroy, Esq., in the above-referenced matter includes statutory provisions that could be claimed against an insurance company regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the CRN fails to identify the specific facts applicable to the listed statutes that were allegedly violated with respect to the subject claim, State Farm is unable to properly respond and said CRN should be rejected and returned. Specifically, Insureds allege the following violations of Florida Statutes: • § 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 and his interests. State Farm strictly denies any violation of any section of Florida Statute § 624.155(1) (b) (1). • § 626.9541(1) (i) (3) (a): Failing to adopt and implement standards for the proper investigation of claims. State Farm strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (a). • § 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(b). • § 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. State Farm strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (c). • §626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(d). • §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. State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(f). • §626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(g). • §626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(h). State Farm specifically denies the allegations that State Farm violated the above referenced statutes. Further, within the section specifically designated for “facts and circumstances giving rise to the violation”, the CRN further alleges the following unsubstantiated violations of Florida Statutes and Florida Administrative Code: • §624.155(1)(B)(1): Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: o 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 towards its insured and with due regard for her interests; o 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or o 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. State Farm strictly denies any violation of Florida Statute §624.155(1)(B)(1). • §624.155 (5): No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: o (a) Willful, wanton, and malicious; o (b) In reckless disregard for the rights of any insured; or o (c) In reckless disregard for the rights of a beneficiaries under a life insurance contract; o (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. State Farm strictly denies any violation of Florida Statute §624.155 (5) and (8). • §627.70131: Insurer’s duty to acknowledge communications regarding claims; investigation o (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. State Farm strictly denies any violation of Florida Statute §627.70131. • § 626.9541(i): Unfair Claim Settlement Practices State Farm strictly denies any violation of any section of Florida Statute § 626.9541(i). Also, the CRN fails to set forth any specific policy language alleged to have been violated in accordance with Florida Statute §624.155(3)(b)(4). Instead, Insureds’ CRN identified the Loss Settlement Provision, without any indication of the actual language at issue. Florida courts have determined that improperly providing the “specific policy language” relevant to the allegations in the CRN renders the CRN ineffective in fulfilling the requirements of bringing an action under Florida Statute §624.155. See Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported, vague, ambiguous, and incorrect allegations with no apparent basis in fact. For example, the CRN alleges that State Farm “used business or outcome-oriented investigation and experts to determine the outcome of the claim” and “failed to properly train, manage, supervise and promote claims adjusters …”. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit and State Farm denies each and every one. State Farm acted in good faith, fairly and honestly toward the Insureds in the adjustment of the instant claim. State Farm was contacted on October 12, 2024, and was informed of a loss at 15510 Mossy Ridge Ln, Lithia, FL33547 (“Property”) that occurred on October 10, 2024, as a result of Hurricane Milton. That claim was assigned claim number 59-75H3-60R. State Farm promptly set up a date and time for an inspection of the Property. The Property was initially inspected on October 29, 2024. On November 4, 2024, State Farm issued a coverage decision letter in accordance with the terms and conditions of the Policy. State Farm has recently been informed that the Insureds were claiming additional damages to the Property, so State Farm requested a re-inspect of the Property. State Farm is still actively investigating this claim. State Farm has been acting in good faith, fairly and honestly toward the Insureds in the investigation of the subject claim. Assuming arguendo, that the real “cure,” sought by the Insureds is payment of all insurance proceeds demanded by the Insured, notwithstanding State Farm’s right to investigate and adjust the loss, the method for curing the violations alleged in a CRN are not determined by Insureds. Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. Section 624.155(2)(d) would have no effect or purpose under such an interpretation. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion, which stated in relevant part, as follows: Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). . . . [t]o cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). Talat, 753 So. 2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). For the aforementioned reasons, the CRN is insufficient as a matter of law. State Farm has also agreed to participate in mediation to promptly bring this claim to a reasonable solution for both parties. It is important to note, that while an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. Neither the subject policy nor does Florida law provide that a carrier must accept whatever demand for repairs it is provided by its Insureds as the amount necessary to repair a loss. In the instant case, the violations alleged by the Insured all revolve around the contention that that State Farm did not accept and pay the Insured’s full demand for repair. In closing, State Farm takes the position that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law, and regardless of the rejection, State Farm denies all allegations contained in the CRN and submits there are no violations to the insured. While this response is meant to be comprehensive, State Farm’s response above is based upon the limited information provided in the CRN and the information State Farm has to date. If the Insured, or Christopher Fauntleroy, Esq., is in possession of information or facts that State Farm is not in possession of, State Farm requests all such information or facts be provided to it immediately. Please note that State Farm’s response is not necessarily exhaustive and does not preclude it from asserting any other valid reason for seeking rejection and return of the CRN. Also, this letter or any act or failure to act on the part of State Farm or any agent or representative of State Farm should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the CRN of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very truly yours, /s/ Kim O’Neill Kim O’Neill, 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