Civil Remedy Notice of Insurer Violations
Login

Filing Number:     805347
Filing Accepted:  2/5/2025
         Print Filing
Complainant
Last/Business Name *  
JUAN TRAVIESO & KATALINA MARTINEZ   First Name  
Street Address * 3811 ERIC CT.
City, State Zip * LAKELAND, FL 33813
Email Address * NONE
Complainant Type: * Insured
Insured
Last/Business Name*   JUAN TRAVIESO & KATALINA MARTINEZ   First Name  
Policy # * FPH3226629-00 Claim #* FP1247988
Attorney
Attorney is Applicable
Last Name* LIGMAN First Name * JOSEPH Initial
Street Address* 15715 S. DIXIE HWY, STE 319
City, State Zip* MIAMI , FLORIDA 33157
Email Address * NONE
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FLORIDA PENINSULA INSURANCE COMPANY
NAIC Company Code 10132
 
Name of individual responsible for violation (if any):* DARELL JUMONONG, BERNIE GACHETTE, ALL UNKNOWN ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY FLORIDA PENINSULA WHO ALSO PERFORMED THE ACTS DESCRIBED BELOW IN RELATION TO THE ADJUSTMENT OF THE SUBJECT CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unfair Trade Practice
Other : Failure to accept or deny coverage within 60 days of the notice of loss
Other : Failure to Properly Investigate Claim with Due Regard to Insured's Interest
* 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.
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.

FLORIDA STATUTES VIOLATED (continued) 627.70131(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 acknowledgment. If the acknowledgment is not in writing, a notification indicating acknowledgment 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. 627.70131(2) - Such acknowledgment shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgment reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgment shall provide necessary claim forms, and instructions, including an appropriate telephone number. 627.70131(7)(a) - Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED 69B-220.201(3) Code of Ethics. The work of adjusting insurance claims engages the public trust. An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: 69B-220.201(3)(b) An adjuster shall treat all claimants equally. 69B-220.201(3)(b)1 An adjuster shall not provide favored treatment to any claimant. 69B-220.201(3)(b)2 An adjuster shall adjust all claims strictly in accordance with the insurance contract. 69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 69B-220.201(3)(e) An adjuster shall handle every adjustment and settlement with honesty, integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled. 69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. 69B-220.201(3)(j) - An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract. 69B-220.201(3)(k) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. 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". This coverage is limited to the “principal building” for the peril of “catastrophic ground cover collapse”. E. Reasonable Emergency Measures 3. As it pertains to protecting and/or covering the roof: a. We will reimburse you to install a tarp in an emergency circumstance, up to 2% of the Coverage A limit of liability. b. We will reimburse you for the cost to remove and reset the tarp to allow for our initial inspection if the claim is reported within 7 days of the first documented installation of the tarp; c. We will not reimburse you for the cost to remove and reset a tarp to allow you or your consultants to inspect, however, in the event the tarp is blown off or damaged by weather, we will reimburse you for the cost to remove and reset a tarp, up to the limits set forth in 1. above; and d. We will not pay more than the limit set forth in 1. above for any type of roof covering, including but not limited to shrink wrap, installed to protect the roof after a loss. e. This 2% temporary emergency roof covering sublimit is separate and apart from, and not combined with the $3,000 limit in 1. above or $3,000 or 1% limit in 2. above. G. Other Coverages 1. Debris Removal a. We will pay the reasonable expense you incur for the removal of: (1) Debris of covered property if a Peril Insured Against that applies to the damaged property causes the loss; b. We will also pay the reasonable expense you incur, up to $500, for the removal from the "residence premises" of: (1) Your tree(s) felled by the peril of Windstorm or Hail or Weight of Ice, Snow or Sleet; or (2) A neighbor's tree(s) felled by a Peril Insured Against under Coverage C; provided the tree(s): (1) Damage a covered structure; or (2) Do not damage a covered structure, but: (a) Block a driveway on the "residence premises" which prevents a "motor vehicle", that is registered for use on public roads or property, from entering or leaving the "residence premises"; or (b) Block a ramp or other fixture designed to assist a handicapped person to enter or leave the dwelling building. The $1,500 limit is the most we will pay in any one loss regardless of the number of fallen trees. No more than $1,000 of this limit will be paid for the removal of any one tree. This coverage is additional insurance. SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against direct loss to the covered property described in Coverages A and B only if that loss is a physical loss to property. Covered property losses are settled as follows: 2. Buildings covered under Coverage A or B at replacement cost, subject to the following: b. If, at the time of loss, the amount of insurance in this Policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this Policy that applies to the building: (1) The actual cash value of that part of the building damaged, after application of the deductible; or (2) That proportion of the cost to repair or replace, after application of the deductible, that part of the building damaged, which the total amount of insurance in this Policy on the damaged building bears to 80% of the replacement cost of the building. d. Under 2.a. and 2.b. above, we will settle the loss as follows: (1) We will initially pay at least the actual cash value of the insured loss, minus any applicable deductible. (2) We will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. 1) looking for ways to deny coverage, pay less, delay payment and otherwise “low ball” or “stone wall” claim; 2) failure to pay claim in full; 3) failure to promptly investigate claim; 4) failure to properly investigate claim; 5) failure to fully adjust loss; 6) failure to act in due diligence and good faith to resolve claim; 7) placing financial interest of insurer before that of policy holders and claimants; 8) failure to properly train, evaluate and manage adjusters. 9) failure to invoke the option to repair. Florida Peninsula has violated the above ethical codes, statutes, and policy provisions by retaining adjusters who, or instructing adjusters to, knowingly underprice and under-scope losses. This creates a situation where adjusters write estimates and adjust losses in a manner prejudicial to the insured by not providing sufficient funds to place the insured in their pre-loss condition, which is what the policy provides for subject to its terms and conditions. The situation created is untenable for the insured. They cannot properly repair the property and return to their normal life. Meanwhile their mortgagee may claim that the homeowner is not protecting the mortgagee’s interest. Additionally, the underwriting department of the insurer may demand that repairs be made prior to renewing or issuing a new policy at the expense of the insured, or worse deny a future claim based upon the insured’s inability to fully repair the property which was the result of the insurer’s bad faith adjustment of the current claim. All of which are bad faith business practices designed to ensure that the insurer pays out as little as possible on any given claim and creates circumstances where it can deny future claims.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the Public Trust. Florida Peninsula Insurance Company (hereinafter “Florida Peninsula”) has breached this duty by its adjustment of its Insureds’ claim of loss. Florida Peninsula’s actions/inactions have forced my client to endure hardship well beyond the covered loss. At no point in the claim process has the insured been treated fairly or in good faith by Florida Peninsula. On or about October 9, 2024, Hurricane Milton hit Florida causing devastating damages througto the insured’s home. The insured made a claim for damages shortly thereafter. After inspection by Florida Peninsula’s representatives, Florida Peninsula refused to make a coverage determination, or proceed to appraisal of the claim, which is tantamount to an outright denial. Also, Florida Peninsula ignored obvious areas of damage that should have been covered under the policy, and therefore did not make any ayment. The insured submitted an estimate totaling approximately $143,911.81 in actual cash value, which received no response. Florida Peninsula refuses to repair the property or produce their damage estimate. The insured requested appraisal of the loss to determine the agreed upon scope of repairs Florida Peninsula rejected the demand. After making its initial inspection Florida Peninsula made it quite clear that it had no intention of dealing fairly with the insured, and properly addressing its duties under the policy. Once it became clear to the insured that they would be unable to obtain fair treatment from Florida Peninsula the insured through counsel gave Florida Peninsula notice of intent to litigate. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of Florida Peninsula have approached this investigation in a biased manner prejudicial to the Insured. Florida Peninsula is using either untrained or improperly trained adjusters in connection with this claim. Florida Peninsula should have been adjusting the loss with the Insured but instead, it was looking for ways not to pay the claim at all or not pay the claim in full. If Florida Peninsula handles all the claims in the manner in which the Insured’s claim was adjusted, then it is improperly handling all claims. Florida Peninsula’s conduct has been reckless and unfair to the Insured. This is evidenced by the delay in paying the claim and accepting coverage for the loss. The Insured was and still is forced to expend out of pocket monies in order to force Florida Peninsula to honor its obligations under the insurance policy, and pay all the insurance proceeds due and owing. Florida Peninsula has refused and/or failed to comply with The Policy’s cooperation and/or Loss Payment provision. Under The Policy and Florida Statute, Florida Peninsula was to timely tender undisputed insurance benefits to the Insured. Florida Peninsula has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of the policy. Florida Peninsula has refused and/or failed to cooperate and/or adjust the Loss by cooperating with the Insured and their representatives during the claims adjustment process in compliance with the Policy’s Loss Payment provision. This is a breach of The Policy. Florida Peninsula has a contractual obligation to not make a perfunctory investigation, and not ignore evidence that would support the Insured’s claim. This is a breach of The Policy. Florida Peninsula has a contractual obligation not to look the other way when confronted with facts revealing the possibility of coverage and resisting reasonable interpretations of its policy. Florida Peninsula has ignored damages in the property and has failed to acknowledge the full scope of the loss despite inspection. This is a breach of The Policy. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or F.S. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insured may mitigate their damages and to put them back into the position they were in prior to the loss as quickly as possible. Florida Peninsula has breached this duty. Florida Peninsula has refused and/or failed to tender all insurance proceeds to the Insureds upon demand. Florida Peninsula’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrongful conduct. Furthermore, the Insured contends that Florida Peninsula’s adjusters and/or representatives financially benefit by such wrongful conduct. Therefore, to cure the defects outlined in this Civil Remedy Notice: Florida Peninsula must put procedures in place to ensure that adjusters are inspecting the actual total scope of a loss such that any payments comprise undisputed benefits under all coverages of the subject policy. Florida Peninsula must acknowledge damages to the dwelling which Florida Peninsula knows, or should know, are covered under the subject policy of insurance. Florida Peninsula must act fairly and honestly towards the Insured and with due regard for their best interests in attempting to settle the Insureds’ claim; and In order to cure their bad faith conduct, Florida Peninsula must immediately tender at least $100,000.00 to the Insured. The insured contends that the indemnity cure amount is supported by the estimate generated by the insured’s public adjuster.
Comments
User Id Date Added Comment
jbosch@qpwblaw.com 04-03-2025 VIA DFS WEBSITE Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Juan Travieso and Katalina Martinez Claim No: FPI1247988 (“subject claim”) Policy No: FPH3226629-00 (“policy”) Loss Location: 3811 Eric Court, Lakeland, FL 33813 (“property”) CRN Filing No: 805347 CRN Acceptance Date: 2/5/2025 RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 805347 Dear Sir or Madam: The undersigned counsel represents Florida Peninsula Insurance Company (“Florida Peninsula”) in regard to the alleged dispute as to the subject claim number listed above involving an alleged windstorm with a date of loss of on or October 9, 2024, made under the Policy of insurance Florida Peninsula issued to the Insureds listed above. This correspondence constitutes Florida Peninsula Insurance Company’s response to the Civil Remedy Notice of Insurer Violations (“Notice” or “CRN”) filed on behalf of Juan Travieso and Katerina Martinez (referenced herein as “Insureds” or “Complainants”) regarding the claim listed above. Based on the below response, the Civil Remedy Notice should be rejected and returned by the Department of Financial Services as it is substantively defective and objectionable for the reasons stated herein, and, without waiving objections, as it completely misstates the facts surrounding this claim. ALLEGED STATUTORY VIOLATIONS 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. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Based on the culmination of Florida Peninsula’s investigations of the claim, the Complainants’ covered damages fell below the Policy’s applicable hurricane deductible. Simply because the outcome of Florida Peninsula’s investigation revealed covered damages less than Complainants’ unjust demand for compensation, does not mean that Florida Peninsula has violated the above statute. 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. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions and the CRN does not include any facts to support this allegation. Florida Peninsula explained why certain items were not covered with policy language and there was no attempt to influence settlement of any portions of the policy or claim. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula did not fail to adopt and implement standards for the proper investigation of the claim. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications for the proper investigation of claims. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and promptly and continually communicated with the insureds and their representatives regarding the Claim. This allegation is without merit. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Based on the culmination of Florida Peninsula’s investigations of the claim, the Complainants’ covered damages fell below the Policy’s applicable hurricane deductible. Simply because the outcome of Florida Peninsula’s investigation revealed covered damages less than Complainants’ unjust demand for compensation, does not mean that Florida Peninsula has violated the above statute. 626.9541(1)(i)(3)(f): Failing to promptly provide a reasonable explanation in writing to the insured of the basis of the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula conducted thorough investigations in good faith and issued its coverage determination based on the Policy’s provisions, conditions, exclusions and endorsements. This Coverage Determination correspondence specifically referenced all claimed damages and conclusions regarding each, and enclosed additional information relating to the claim, as well as information relating to the Department of Financial Services mediation services. This allegation is without merit. 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and promptly and continually communicated with the insureds and their representatives regarding the Claim. This allegation is without merit. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and promptly and continually communicated with the insureds and their representatives regarding the Claim. This allegation is without merit. In addition to the above statutory provisions, Complainants also briefly and vaguely indicates the Florida Peninsula has violated the following Florida Statutes: 627.70131(1)(a), 627.70131(2), 627.70131(7)(a), 69b-22-.201(3), 69b-22-.201(3)(b), 69b-22-.201(3)(b)1., 69b-22-.201(3)(b)2., 69b-22-.201(3)(c), 69b-22-.201(3)(d), 69b-22-.201(3)(e), 69b-22-.201(3)(f), 69b-22-.201(3)(j), and 69b-22-.201(3)(k). However, the allegations regarding violations of these statutory provisions contain absolutely no facts whatsoever in support of same. Rather, Complainants merely provide the above list without further explanation in violation of the specificity requirements under Florida law. While these allegations are improper and incomplete as a matter of law, Florida Peninsula denies each and every alleged violation in an abundance of caution. In addition to the allegations specifically denied above, Florida Peninsula generally denies all allegations presented in this CRN, as Florida Peninsula has not violated any statute, Code or Rule. SPECIFICITY REQUIREMENTS Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to “cure” the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the Insureds’ contentions, including but not limited to, those that would be necessary for Florida Peninsula to “cure” the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that Florida Peninsula could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So. 3d 875 (Fla. 4th DCA 2021). For the reasons set forth herein, Florida Peninsula hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate. As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, the Insureds failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them. The Insureds’ failure to describe any actual facts or circumstances to support the alleged statutory violations in the CRN precludes Florida Peninsula from evaluating what error, if any, allegedly occurred during the claim process. 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 and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and Florida Peninsula is unable to determine what specifically the Complainant is claiming was done by or on behalf of Florida Peninsula that constitutes the bad faith alleged. Due to the absence of specific and accurate information regarding the alleged acts or omissions by Florida Peninsula which allegedly give rise to any violation of the Civil Remedy Statute, Florida Peninsula is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, Florida Peninsula explicitly denies violations of any applicable Florida Statute in the adjustment of the subject claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above. Florida Peninsula maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insured’s claim. Further, Florida Peninsula wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the subject claim by Florida Peninsula. Additionally, the CRN fails to state with specificity the facts relevant to any alleged policy violation. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). The CRN merely refers to general language without any details as to how any provisions were actually violated. Thus, the CRN does not satisfy the requirements. BACKGROUND FACTS Aside from the fact that the allegations contained in the subject CRN lack specific facts, the tenor and inferences of statutory violations are wholly without merit, and Florida Peninsula denies each and every one. Below are some of the relevant facts regarding the subject claim that the Insureds failed to include in the CRN. On October 11, 2024, Insured, Juan Travieso, contacted Florida Peninsula to report a claim for windstorm damage sustained as a result of Hurricane Milton. The Insured reported that as a result of the storm, the property’s interior, specifically the living room and dining room, the property’s roof, including the siding, and the garage. Additionally, it was reported that there is mold, leaks and flooding. No further information regarding the alleged damage was provided at the time of the initial reporting of the claim. Immediately, the same day, Florida Peninsula sent correspondence to the Insureds acknowledging receipt of the claim. Upon receiving notice of the Insureds’ claim, Florida Peninsula retained an independent field adjuster to inspect and evaluate the Insured’s property and reported damages, which was conducted October 24, 2024. On November 7, 2024, Florida Peninsula issued its coverage determination informing the Insureds that coverage was afforded, however, the damage to the property was less than the policy’s hurricane deductible. Therefore, Florida Peninsula could not make a payment on the claim. Florida Peninsula also included with its Coverage Determination Letter, an Estimate, Statement of Loss, and Mediation Statement. On November 12, 2024, Florida Peninsula received correspondence from Insureds’ public adjuster, Ron Arango PA at Moreau Consultants, Inc., along with a letter of representation. On November 13, 2024, Florida Peninsula acknowledged receipt of the letter of representation. On December 5, 2024, Florida Peninsula received correspondence from Insureds’ public adjuster including a demand letter, requesting an appraisal and proof of loss. On January 6, 2025, Florida Peninsula issued its response to Insureds’ public adjuster acknowledging receipt of their appraisal demand letter and proof of loss. On January 10, 2025, Florida Peninsula issued correspondence to the Insureds, and their representatives, stating: We received an appraisal demand letter from Moreau Consultants LLC on 01/09/2025 pertaining to this claim. Please not that our insured’s policy FP HO 03 10 23 does not have a provision for appraisal. Therefore, we must reject the appraisal demand. That same day, Florida Peninsula requested a reinspection of the Insureds’ property, which was declined by the Insureds’ public adjuster. On January 20, 2025, Florida Peninsula issued correspondence to the Insureds’ public adjuster, stating that appraisal is only available if the insured is offered and accepts to be in the managed care program. Additionally, Florida Peninsula states that they have not offered that program to the insured, and therefore, appraisal is not available. Florida Peninsula issued a letter, dated January 20, 2025, regarding the request for the reinspection of the property. In its letter, Florida Peninsula stateD: Your policy requires you to cooperate with our investigation and to allow us to re-inspect, including but not limited to taking photographs and/or video of the property. Your public adjuster was contacted to set up the reinspection, but no date was set, yet. Florida Peninsula also included in its letter, the applicable policy language. On January 28, 2025, Florida Peninsula received a Notice of Intent to Initiate Litigation from Insureds’ attorney representative. On January 30, 2025, Florida Peninsula issued correspondence to the Insureds, and their representatives, following up on the rejection of Florida Peninsula’s request for a reinspection. In its letter, Florida Peninsula stated that they were providing its reservation of rights and continuing demand to allow an inspection. In its letter, Florida Peninsula explains: We must remind you of the below Duties After Loss and any failure to comply could result in prejudice in our investigation and could result in a decline of your claim based on the policy requirements. Florida Peninsula also included with its letter, the applicable policy language and the policy excerpt labeled “Your Duties After Loss.” On February 5, 2025, Florida Peninsula received this Civil Remedy Notice. On February 10, 2025, Florida Peninsula acknowledged Insureds’ Notice of Intent to Litigate and estimate of damages. In its letter, Florida Peninsula states: As you know, we completed our investigation of the claim and sent you correspondence detailing the basis of our coverage determination pursuant to the terms and conditions of your Policy. On November 7, 2024, we sent you a letter and a copy of the estimate prepared by our field adjuster, a copy of which is attached hereto. Based on the estimate, the damage to your property was less than your deductible in the amount of $22,195. Florida Peninsula also included a copy of the Estimate and prior correspondence. As you can see, Florida Peninsula conducted a good faith comprehensive and prompt investigation of this claim. Florida Peninsula consistently and promptly communicated with the Insureds and their representatives and conducted an inspection of the property. Florida Peninsula afforded coverage based on an inspection and thorough investigation of the claim. Florida Peninsula respectfully denies any wrongdoing in the adjustment and handling of the Subject Claim, and further denies any and all allegations that it violated any statutes. Instead, Florida Peninsula acted quickly and responsibly and in accordance with the terms and provisions of the applicable Policy of insurance as well as with F.S. §624.155 and §626.9541 and its sub-parts. INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN The case specific facts related to Florida Peninsula’s handling of the subject claim provided above implicitly address many of the vague allegations contained within the Insureds’ CRN and further establish that Florida Peninsula undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. It is important to note that the Insureds have not provided any factual support for any of the above allegations. Instead, the facts support that Florida Peninsula promptly contacted the Insureds, inspected the claim shortly after it was reported, and issued a coverage determination based on a thorough investigation. When additional information was provided, Florida Peninsula conducted additional investigations. The circumstances support that Florida Peninsula conducted a good faith, thorough, prompt investigation with the information provided. The Insureds are alleging bad faith in a scenario where Florida Peninsula conducted a comprehensive, prompt investigation in good faith. 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 Civil Remedy Notice itself only provides completely false allegations with no basis in fact or circumstances. As clearly set forth above and contrary to the allegations set forth in the Notice, Florida Peninsula’s investigations and adjusting of its Insureds’ claim were prompt, thorough, and complete. When additional information was provided, the claim was further investigated and correspondence sent to the Insureds. Furthermore, the Insureds have included absolutely no facts or evidence to support any claims in the Notice. All of these baseless claims support Florida Peninsula’s position that the claim was properly adjusted, and the Insureds do not actually have any concrete facts to support a bad faith allegation. As mentioned, mere disagreement as to the coverage determination, or the amount of coverage, does not equate to bad faith. The Civil Remedy Notice does not show how Florida Peninsula has failed to comply with the statutory provisions alleged to have been violated. Evidently, this Civil Remedy Notice was filed in bad faith, as it is being used as an improper mechanism designed solely for the purpose of intimidating Florida Peninsula into potentially overpaying the Insureds. For the aforementioned reasons, Florida Peninsula categorically denies that it has acted with bad faith in connection with this claim. CONCLUSION The purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how FPIC can “cure” the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. 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). . . . To 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). Here, Florida Peninsula properly afforded coverage for the subject claim as it investigated the loss within the statutory time frame and informed the Insureds that the damage amount fell below the Hurrican Deductible. Florida Peninsula denies all of the allegations contained in the subject CRN, which is defective and improper, as Florida Peninsula has not violated any of the subject statutes. Florida Peninsula further states that the accusations made against it in the subject CRN are patently false. In closing, Florida Peninsula first believes that the Civil Remedy Notice 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. Due to the lack of any factual and circumstantial basis to support the allegations therein, Florida Peninsula respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, Florida Peninsula denies all allegations contained in the Civil Remedy Notice and submits there are no violations. While Florida Peninsula’s response herein is meant to address the allegations in the Insureds’ Notice, it is based upon the limited information provided in the Civil Remedy Notice and the information presented to date. If the Insured feels that Florida Peninsula is not in possession of all the facts, please inform the undersigned immediately. Please note that Florida Peninsula’s response is not necessarily exhaustive and does not preclude Florida Peninsula or anyone on Florida Peninsula’s behalf from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Florida Peninsula or any agent or representative of Florida Peninsula 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. On behalf of Florida Peninsula, we trust that this response addresses the allegations 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. Very Truly Yours, QUINTAIROS, PRIETO, WOOD & BOYER, P.A.
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