Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 804935

Filing Accepted: 2/4/2025

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Complainant

Last/Business Name *

CARRILLO

First Name

ANDRES DAVID

Street Address *

641 SW 16TH STREET

City, State Zip *

BOCA RATON, FL 33486

Email Address *

DAVID.CARRILLO@JWH.COM

Complainant Type: *

Insured

Last/Business Name*		CARRILLO		First Name		ANDRES DAVID
Policy # *		HCPC-HO3-137190-2		Claim #*		914506

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):* LEE VORCHEIMER, NATALIE BANNER AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, HOMEOWNER'S CHOICE PROPERTY & CASUALTY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM AND UNKNOWN TO THE INSURED.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Unfair Trade Practice
	Other : Not treating the policyholder with good faith claims conduct
	Other : Looking for ways to deny full recovery to the Insureds
	Other : Looking for ways to delay full recovery to the Insureds
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
	Other : Failing to provide the Insureds with the full benefits awarded to him under the contract of insuranc

* 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)(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)(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.
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.

Homeowner's Choice Property & Casualty Insurance Company (the "Insurer") has committed the following in handling the Insureds' 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 Claimant; 3) not adjusting the claims promptly and fairly; 4) not attempting in good faith to settle claims; 5) looking for ways to delay benefit payments; 6) requesting a re-inspection only after the Insureds retained a public adjuster; 7) shifting the burden of investigating the loss onto the Insureds; 8) conducting inadequate investigations; and 9) making material misrepresentations of the coverages afforded under the insurance policy. The Claimant timely submitted a claim to the Insurer for wind damage sustained to the above-referenced insured property, including any ensuing damage therefrom. The Insurer replied with an estimate dated October 27, 2021 wrongfully stating that only $2,586.97 was due to their Insured at that time for the substantial damage. Due to the scope and nature of the damage, the Insured retained a public adjuster who, in a report dated November 2, 2021, revealed covered damages of $ $137,005.68 to the dwelling. In a letter dated April 6, 2022, the Insurer restated their wrongful position. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to wrongfully underpay the Claimant. This is an underhanded attempt to place the financial interests of the Insurer over those of the Claimant and to delay and frustrate the Claimant's ability to have his claim adjusted promptly to begin restoring his property. The Insurer upon the Claimants' loss had the duty to provide the full benefits under the policy. This includes providing the Claimants with a proper investigation and the funds necessary to return their home to its pre-loss condition. Despite the obvious covered damage under this All-Risk policy, the Insurer here placed its financial interest over the health and safety of the Claimant. The initial investigation by the Insurer's field adjuster was inadequate. As a result of the inadequate investigation and surrounding circumstances, it is apparent that the Insurer significantly underestimated the scope of the loss to the Claimant's property. The Insurer's estimate of the insured property's loss simply would not restore the property to its pre-loss condition which is Insurer's duty under its own contract of insurance. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement cost of the damages. This is an underhanded attempt to place the financial interest of the Insurer over those of the Claimant, to delay the Claimant's claim, and to delay the Claimant's ability to restore the property to its pre-loss condition. Moreover, Insurer shifted the burden and cost of investigating and insuring the loss onto the Claimant. The Insurer upon the Claimant's loss had the duty to provide the full benefits under the policy. This includes providing the Claimant with the proper investigation and the funds necessary to return their home to its pre-loss condition. The Insurer is placing its financial interest over the health and safety of the Claimant. The Insurer's field adjuster knew or should have known that over 25 percent of the Claimant's roof was damaged as a result of a covered peril, and presumably did. The Insurer also knows that the Claimant needs a new roof in order to comply with the Florida Building Code, because more than 25 percent of the Claimant's roof is damaged and matching roofing tile cannot be purchased. The Insurer did not allocate enough coverage to pay for a full re-roof despite knowing it is obligated to do so. According to Florida Statute s. 627.7011(1)(b), Insurers have a duty to cover all costs necessary to meet applicable laws and ordinances regulating the repair of any property and Florida Statute s. 626.9744 requires that the Insurer make reasonable repairs or replacement that match the quality, color or size of the items that needs repair. This has further delayed the Claimant from being able to restore the property to its pre-loss condition and is an underhanded attempt to place the financial interest of the Insurer over Claimant. Moreover, the Insurer unreasonably inflated the amount of recoverable depreciation in this case, thereby artificially lowering the Claimant's recoverable value, to the detriment of the Claimant. The Insurer withheld an exorbitant amount of the net claim determined by the Insurer as recoverable depreciation. The Insurer has attempted to gain an unreasonable financial benefit by inflating the recoverable depreciation because it knows that it is unlikely, or at least less likely, that the Claimant can actually complete the repairs which is a condition precedent to the recovery of the depreciation withheld under the claim. In other words, the Insurer pays an unreasonable amount less on the front end of a claim, which makes it more difficult for the Claimant to restore the property to its pre-loss condition and recover the withheld depreciation from the Insurer. Only after Insured pays to restore the property out of pocket, if he can, will the Insurer fully pay its Insured under the policy. Withholding an inflated amount of depreciation is a creative, sneaky, and deceptive practice that is employed as to limit the amount the Insurer will ever have to pay out on a claim and essentially make the homeowner a self-insured. The Insurer is hoping that the Claimant is unaware of her right to recover the recoverable depreciation so that it can pay Claimant less than it is obligated. The Insurer is shifting the cost and the burden of investigating the loss onto the Claimant. The Insurer has the duty to inspect the loss and provide the Claimant with the full benefits under the policy. The Insurer has breached that duty by not providing the Claimant with the full value of the loss and caused the Claimant to take on the burden of investigating the loss. In short, Insurer is not acting with due regard for the Insureds' interests or safety. In Florida the work of adjusting insurance claims engages the public trust. Insurers have a duty to treat all Claimants equally and the Insurer has breached this duty. The Insurer has conducted poor and inadequate investigations and has significantly underestimated the replacement costs of Insureds' property to further frustrate and delay the Claimants' claim. The Insurer is placing their financial interests over those of the Claimants and the Claimants' safety. The foregoing has only delayed the Claimants' ability to begin restoring their home to its pre-loss condition. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the policyholder with good faith claims conduct 3. Looking for ways to reduce recovery to the Insureds 4. Looking for ways to deny recovery to the Insureds 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. 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 7. Placing the financial interest of the Insurer over that of the Insured 8. Requesting a re-inspection only after the Insureds retained a public adjuster 9. Treated represented and unrepresented Insureds differently 10. Shifting the burden of investigating the loss onto the Insureds 11. Conducting inadequate investigations 12. Making material misrepresentations of the coverages afforded under the insurance policy. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) Admit full coverage for the Insureds' loss. (2) Tender full benefits owed to the Insureds under the insurance contract. (3) Implement policies and procedures to ensure that all Claimants are treated with equal fairness to the investigation of claims. 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 Electronic Mail: HOMEOWNERS CHOICE PROPERTY AND CASUALTY INSURANCE COMPANY P.O. Box 22967 Tampa, Florida 33622 MIREDYS GONZALEZ PORTIELES, ESQ Email: mgonzalez@hcpci.com

Comments

User Id		Date Added		Comment
Legal@hcpci.com		04-04-2025		This is Homeowners Choice Property & Casualty Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by attorney Grant Krapf on behalf of Andres David Carrillo (“Insured”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Regarding an aspect of the claim, HCPCI issued payment for it on the information available to HCPCI and the circumstances at the time of such payment. 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