Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 805130

Filing Accepted: 2/4/2025

Print Filing

Complainant

Last/Business Name *

PARKER

First Name

GEORGE & PILAR

Street Address *

320 MONET DRIVE

City, State Zip *

NOKOMIS, FL 34275

Email Address *

WITHHELD

Complainant Type: *

Insured

Last/Business Name*		PARKER		First Name		GEORGE & PILAR
Policy # *		HCPC-HW2-463350-8		Claim #*		943794

Attorney

Attorney is Applicable

Last Name*	WALLACE First Name * BLAKE Initial
Street Address*		8635 W. HILLSBOROUGH AVE., STE. 401
City, State Zip*		TAMPA , FLORIDA 34275
Email Address *		BLAKE@KLINGLAW.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):* TYLER KEITH
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	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.
	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)(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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the “residence premises”. B. Coverage B – Other Structures 1. We cover other structures on the “residence premises” set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. PERIL INSURED AGAINST 1. We insure for direct physical loss to the property described in Coverages A, B and C caused only by the peril of windstorm or hail unless the loss is excluded in EXCLUSIONS. 2. With respect to paragraph 1. above, coverage for loss caused by a Peril Insured Against includes loss to: b. The inside of a building or the property we cover contained in a building caused by: (1)Rain; (2)Snow; (3)Sleet; (4)Hail; (5)Sand; or (6)Dust; if the direct force of the windstorm or hail first damages the building, causing an opening through which the rain, snow, sleet, hail, sand or dust enters and causes damage. I. 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. Any loss payment will be paid to you and them, as each interest appears. Loss will be payable: 1. 20 days after we receive your proof of loss and reach written agreement with you; or 2. 60 days after we receive your proof of loss and: a. There is an entry of a final judgment; or b. There is a filing of an appraisal award or a mediation settlement with us. 3. Within 90 days after we receive notice of an initial, reopened, or supplemental property insurance claim from you, where for each initial, reopened, or supplemental property insurance claim, we shall pay or deny such claim or portion of such claim, unless there are circumstances beyond our control which reasonably prevent such payment. CALENDAR YEAR HURRICANE DEDUCTIBLE– FLORIDA A. Loss By Windstorm During A Hurricane With respect to Paragraphs C. and D., coverage for loss caused by the peril of windstorm during a hurricane which occurs anywhere in the State of Florida, includes loss to: 1. The inside of a building; or 2. The property we cover contained in a building caused by: a. Rain; b. Snow; c. Sleet; d. Hail; e. Sand; or f. Dust; If the direct force of the windstorm first damages the building, causing an opening through which the rain, snow, sleet, hail, sand or dust enters and causes damage. D. Application of Calendar Year Hurricane Deductible 1. In the event of the first windstorm loss caused by a single hurricane occurrence during a calendar year, we will pay: Only that part of the total of all loss payable under Property Coverages that exceeds the calendar year hurricane deductible stated in your Declarations. 2. With respect to a windstorm loss caused by the second, and each subsequent, hurricane occurrence during the same calendar year; a. We will pay only that part of the total of all loss payable under Property Coverages that exceeds the greater of: (1)The remaining dollar amount of the calendar year hurricane deductible that is in effect at the time of the loss; or (2)The deductible that applies to other windstorm or hail that is in effect at the time of the loss. b. The remaining dollar amount of the calendar year hurricane deductible is determined by: (1)Subtracting the actual deductible(s) applied to all previous windstorm losses caused by hurricanes during the calendar year; (2)From the calendar year hurricane deductible that is in effect at the time of the loss.

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

February 4, 2025 Sent Via Email Homeowners Choice Property & Casualty Insurance Company claims@hcpci.com RE: Insureds : GEORGE PARKER AND PILAR PARKER (hereinafter, “Insureds”) Policy # : HCPC-HW2-463350-8 Claim # : 943794 Property Address : 320 Monet Dr, Nokomis, FL 34275 Persons most knowledgeable of facts giving rise to the Violations: Tyler Keith Dear Homeowners Choice Property & Casualty Insurance Company: Please find enclosed the civil remedy notice filed for the above referenced claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the claimant’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its claimant and with due regard for its interests. The carrier has done everything possible to delay the claim and refuses to provide any sort of status of the claim. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insured…”). The carrier was put on notice of the insured’s Hurricane Ian claim. Since the commencement of the claim the carrier has failed to timely communicate with the insured. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy. The carrier assigned an unnamed field adjuster, who is not an engineer, to inspect the loss. On October 11, 2024, the carrier made the unilateral determinations based on the observations of the unnamed field adjuster that the damages to the property would be excluded under the policy and therefore be denied. In reaching this conclusion, Frontline failed to adopt and implement standards for the proper investigation of claims. There was no explanation whatsoever as to how Frontline determined which items of damage were caused by excluded perils or how they were caused by excluded perils. This is in violation of F.S. §626.9541(1)(i)(3)(f) as Frontline failed 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 the claim. Furthermore, the carrier’s failure to assign a qualified and experienced engineer further violates F.S. §626.9541(1)(i)(3)(a). Moreover, as the carrier denied coverage without conducting a reasonable investigation based upon available information, the carrier violated F.S. §626.9541(1)(i)(3)(d). Florida Statute 627.70131(3)(e) requires the carrier to provide an estimate within 7 days after the estimate is generated by the insurer’s adjuster. However, here, Homeowners Choice failed to provide any copy of a report created and/or generated by its field adjuster. The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $49,000.00 that would be needed to repair the property back to its pre-loss condition. The insured has complied with all the carrier’s requests to date. The carrier has still refused to pay the fully covered amount owed under the policy, instead electing to stand by its unilaterally determined deficient valuation of the loss while denying the rest of the loss. This is in violation of F.S. 624.155(1)(b)(1) and 624.155(1)(b)(3) as the carrier is clearly placing the company’s interests before the claimant’s interests and not attempting in good faith to settle claims. Furthermore, it is further in violation of F.S. §626.9541(1)(i)(3)(a) as the carrier failed to adopt and implement standards for a proper investigation of the claim. It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the claimant’s loss in a timely manner. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(d), 627.4137(1), and Fla. Stat. §627.70131. The actions taken by Homeowners Choice in the handling/adjustment of the insured’s claim were willful, wanton, malicious, and in reckless disregard for the rights of any insureds and occur with such frequency as to indicate a general business practice, and further are in violation of Florida Statutes §624.155 and F.S. §626.954. Indeed, when performing a search on the Florida Department of Financial Services website’s Civil Remedy Notice of Insurer Violation page the results of searches of violations of the statutes referenced herein by the carrier returned the following results thereby indicating that the number of times they occur rise to the level of a general business practice, and warrant punitive damages: §624.155(1)(b)(1) = 4,055 §624.155(1)(b)(3) = 2,873 §626.9541(1)(i)(3)(a) = 3,832 §626.9541(1)(i)(3)(c) = 2,723 §626.9541(1)(i)(3)(d) = 2,243 §626.9541(1)(i)(3)(f) = 2,163 Based upon the above-referenced acts and omissions, the carrier has breached the insurance contract by failing to pay the amount due to the insured, by denying coverage which existed under the insurance contract with the insured in the instant dispute, by failing to adjust the loss with the insureds, and by failing to perform and adequate investigation. These are violations and breaches of the policy language cited above. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $49,000.00 less any applicable policy deductible; and 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been emailed to the carrier. The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. The other provisions are pasted on the pages following the signature block. If you have any questions or concerns, please send all correspondence via email to Blake@klinglaw.com and Jorlyn@KlingLaw.com to ensure a prompt response. We ask that all correspondence be done via email rather than regular mail. Should you need to send something regular mail, please advise us prior to sending same via the emails above. Sincerely, Blake M. Wallace, Esq. Blake M. Wallace Attorney at Law Enclosed: Civil Remedy Filing

Comments

User Id		Date Added		Comment
Legal@hcpci.com		04-04-2025		This is Homeowners Choice Property & Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Blake Wallace, Esq. on behalf of George & Pilar Parker (“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; failed to offer a valid cure; 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). 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