Civil Remedy Notice of Insurer Violations
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Filing Number:     805195
Filing Accepted:  2/5/2025
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Complainant
Last/Business Name *  
AMANDA MABRY   First Name   SCOTT MABRY AND
Street Address * 10251 AUTHORS WAY
City, State Zip * ORLANDO, FL 32832
Email Address * AMANDAWOLF15@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   AMANDA MABRY   First Name   SCOTT MABRY AND
Policy # * 7709HR029447 Claim #* 162922-GP
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*   NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANY
NAIC Company Code 37877
 
Name of individual responsible for violation (if any):* THOMES BUCHANAN, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, NATIONWIDE MUTUAL INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
Other : Making material misrepresentations
* 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)(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)(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.

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.

Nationwide Property and Casualty Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insureds; and 10) making material misrepresentations On or about September 11, 2023, while the subject policy was in full force and effect, the insured property suffered a loss caused by hail and wind. The Insured timely submitted a claim to the Insurer for wind and hail damages and ensuing damage therefrom. Thereafter, the Insurer assigned claim number 162922-GP to the loss and sent a field adjuster to inspect the property. Then in a coverage determination letter dated October 31, 2023, the Insurer notified the Insured that it was denying coverage for the loss. Given the denial and the scope and nature of the damage, the Insured retained a roofing contractor. After assessing the damage and the true scope of repairs, the roofing contractor prepared an estimate identifying $50,820.00 in covered damage to the roof and $5,213.00 in covered damage to the solar panel system. The foregoing estimate and photographs were sent to the Insurer. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and issued a wrongful denial. The Insurer based this denial on the rationale that the damage sustained was " a result of wear, tear, and deterioration." However, the Insurer never retained an engineer to ascertain the cause of damage to the Insured's roof. Although the Insurer and Insured are in dispute about how the roof was damaged, 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 undervalue the reported loss and pay the Insured as little as possible. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. The conduct outlined above is done within the Insurer's routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. 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 subject 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 claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's' interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations 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: Attorney for Nationwide Property and Casualty Insurance Company Douglas P. Gerber, Esquire Gerbed1@nationwide.com
Comments
User Id Date Added Comment
grant@krapflegal.com 12-10-2025 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice. This Civil Remedy Notice is hereby withdrawn.
tabadc1@nationwide.com 02-20-2025 Nationwide has responded to the Civil Remedy Notice on 02/20/2025.
gerbed1@nationwide.com 02-20-2025 February 20, 2025 Grant W. Krapf Krapf Legal 2790 Sunset Point Road Clearwater, FL 33579 COMPLAINANTS: Scott and Amanda Mabry INSUREDS: Scott and Amanda Mabry POLICY NUMBER: 7709HR029447 OUR CLAIM NUMBER: 162922-GP DATE OF LOSS: September 11, 2023 DFS FILE NUMBER: 805195 Mr. Krapf: This correspondence constitutes Nationwide Mutual Insurance Company’s (“Nationwide”) response to the Civil Remedy Notice of Insurer Violation (“Notice”) filed by attorney Grant Krapf on February 5, 2025 on behalf of complainants, Scott Mabry and Amanda Mabry (collectively the “Complainants”), regarding the claim listed above. This response is timely filed. While Nationwide welcomes the opportunity to respond to this Notice and specifically denies each and every allegation contained in the Notice filed in relation to this claim, Nationwide asserts that the Notice is deficient as it fails to comply with the requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions as set forth in Florida Statute §624.155 and applicable case law. The Civil Remedy Notice strictly requires the Complainant "pursuant to section 624.155, F.S. to indicate all statutory provisions alleged to have been violated." The Notice filed by you in this matter includes almost every statutory provision that could be claimed against an insurance company, regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. The Notice alleges unfair trade practice, claim denial, claim delay, bad faith conduct, failure to investigate, not adjusting claims and evaluating loss properly, failing to implement proper standard for the adjustment and investigation of claims, making material misrepresentations, and generally tracks the language of several sections of Florida’s Civil Remedy Statute. Specifically, the Notice alleged multiple statutory violations including Fla. Stat. §624.155(1)(b)(1), §624.155(1)(b)(3), §626.9541(1)(i)(2), §626.9541(1)(i)(3)(a), §626.9541(1)(i)(3)(b), §626.9541(1)(i)(3)(c), §626.9541(1)(i)(3)(d), and §626.9541(1)(i)(3)(i). However, no specific facts or circumstances are provided to support these allegations. Because the Notice fails to identify any specific facts or circumstances, Nationwide is unable to properly respond and maintains that the Notice is defective. In addition, the alleged violation of section 626.9541(1)(i)(3)(i) is not applicable because the above-referenced claim does not involve or include a personal injury claim. Additionally, the Notice fails to specific policy language alleged to have been violated in accordance with Florida Statute §624.155(3)(b)(3) and §624.155(3)(b)(4). This failure to identify the the facts that allegedly give rise to Nationwide’s alleged violations prevent Nationwide from addressing any issues regarding the policy and is further reason why it does not comply with Florida Statute §624.155. Furthermore, the Civil Remedy Notice only provides unsupported and incorrect allegations with no basis in fact or circumstances. Notwithstanding the deficiencies in the Notice, Nationwide denies it committed the alleged acts or violated the statutes cited in the Notice and asserts that this is another reason why the Notice is defective. Nationwide handled the claim properly, timely and in good faith at all times by investigating the claimed loss as reported, issuing appropriate coverage letters and offering to review any relevant correspondence or documentation submitted. Specifically, on October 25, 2023, Amanda Mabry (“Insured”), first reported a claim for alleged roof and interior damage from a wind/hail storm with an alleged date of loss of September 11, 2023 (“Loss”) to Nationwide. Finally, the Civil Remedy Notice contains “cures” for the alleged defects, however, according to legal counsel, there are “cures” that are improper pursuant to Florida Case law, specifically the case of Talat Enterprises, Inc., v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1281 (Fla. 2000). Legal counsel asserts that the Talat case provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amount due. Talat also commented that "It naturally follows that for there to be a "cure," what had to be "cured" is the non-payment of the contractual amount due the insured. In the context of a first-party insurance claim, the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled....” As a result, as stated by legal counsel, only the demanded “cures” relating to the payment for covered damages are proper and legal – the remaining “cures” are improper remedies and contrary to Florida law. In short, the Notice is deficient due to its failure to comply with Florida Statute §624.155 and applicable case law, and Nationwide denies all allegations contained in the Civil Remedy Notice and believes that all alleged violations have been cured. Nationwide denies that it has done anything improper. At all times, Nationwide handled the claim properly and in good faith. Nationwide has communicated the claims position now six times since January 24, 2024 in response to the previous Civil Remedy Notices filed by the Complainants. For example, the above-referenced filing is identical to the Civil Remedy Notice filed by the Complainants on August 13, 2024 (DFS filing 777711) and responded to on October 8, 2024. Nationwide's position remains unchanged as outlined in its previous responses and are incorporated by reference in this response. While this response is meant to be comprehensive, Nationwide’s response above is based upon the limited information provided in the Civil Remedy Notice and the information we have to date. If attorney Grant Krapf or the complainant, Amanda Mabry, feel that we are not in possession of all the facts, please inform us immediately. Please note that Nationwide’s response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for disputing the form, contents or allegations of the Notice. Also, this letter or any act or failure to act on the part of Nationwide or any agent or representative of Nationwide should not be construed as a waiver of any rights or defenses, including by not limited to proper notice and service by the Insured, 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 Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Best Regards, /s/ Doug Gerber Doug Gerber
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