Civil Remedy Notice of Insurer Violations
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Filing Number:     805480
Filing Accepted:  2/6/2025
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Complainant
Last/Business Name *  
PINA   First Name   CARMEN DE; FELIX
Street Address * 16618 SW 99TH LANE
City, State Zip * MIAMI, FL 33196
Email Address * FMRPT@ATT.NET
Complainant Type: * Insured
Insured
Last/Business Name*   PINA   First Name   CARMEN DE; FELIX
Policy # * 79-C6-H559-9 Claim #* 59-61V9-34J
Attorney
Attorney is Applicable
Last Name* BRAZ First Name * TAMARA Initial
Street Address* 8865 COMMODITY CIR. STE. 12
City, State Zip* ORLANDO , FL 32819
Email Address * TBRAZ@THELAWGICALFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* ? AL NUNEZ, CLAIMS SPECIALIST ON BEHALF OF STATE FARM FLORIDA INSURANCE COMPANY; ? SHENA TURNER, CLAIMS SPECIALIST ON BEHALF OF STATE FARM FLORIDA INSURANCE COMPANY;
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Improper Investigation
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

POLICY FORM: FORM: HW-2159 *** SECTION I – PROPERTY COVERAGES *** COVERAGE A – DWELLING 1. Dwelling. We cover the dwelling and materials and supplies located on or adjacent to the residence premises for use in the construction, alteration, or repair of the dwelling or other structures on the residence premises. *** HW-2159 *** SECTION I – LOSSES INSURED *** COVERAGE A – DWELLING We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded[…] ***
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about September 19, 2023, Carmen De Pina and Felix Pina (Complainant(s)) suffered a loss to their Property, located at the address listed above due to wind. After discovering the damage, Complainant(s) promptly reported the loss to State Farm Florida Insurance Company (“Insurer”). Throughout the Insurer’s investigation, Complainant(s) have fully cooperated with the Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant(s) custody, possession and control. The Insurer, however, has failed to fulfill its duties under the Policy and Florida law. On or about January 10, 2024, Complainant entered into a contract with Adjuster Group, a public adjuster (hereinafter “Public Adjuster”). Subsequently, on or about January 29, 2024, Complainant retained Centurion Restorations to conduct water mitigation efforts and install a tarp to safeguard the property from further damage. Centurion Restorations completed these services on or around February 4, 2024, and issued an invoice for $13,640.96. On or about February 12, 2024, Public Adjuster conducted an inspection of the property and took 53 photographs. Following this inspection, on or about February 13, 2024, the Public Adjuster prepared an estimate of the property damage, which amounted to $97,619.86 in Actual Cash Value. This estimate was submitted to Insurer for review. Shortly thereafter, X Mold Assessment conducted a mold inspection at the property and submitted an invoice of $3,000 to Insurer for services rendered. On or about March 7, 2024, a field adjuster retained by Insurer conducted an inspection of the property. Insurer issued a coverage determination letter on or about March 23, 2024. This letter included an estimate and payment breakdown totaling $17,257.07. The payment covered Centurion Restorations’ invoice of $13,640.96, the $3,000 mold remediation invoice, and Insurer’s own estimated damages of $2,308.03, minus a $3,100 deductible. However, Insurer’s payment and estimate egregiously fell short of addressing the actual damages required to restore the property to its pre-loss condition. Insurer’s determination relied on findings from the field adjuster’s inspection, which attributed the damages to causes such as “long-term thermal expansion/contraction,” “normal wear and tear,” and “possible footfall.” Despite these assertions, Insurer failed to provide any expert analysis or evidence to substantiate these claims. A field adjuster’s role is to document observed damages, not to assess causation or determine coverage. Despite this, Insurer improperly relied on the adjuster’s sole unqualified observations as the basis for its partial-denial of the full claim. The Public Adjuster’s estimate, totaling $97,619.86, far exceeded Insurer’s estimate of $2,308.03. Despite having knowledge of this substantial discrepancy prior to litigation, Insurer failed to conduct a thorough investigation or engage a qualified expert to resolve the matter. This failure constitutes a clear violation of Fla. Stat. 626.9541(1)(i)(3)(a), which requires insurers to adopt and implement standards for the proper investigation of claims. On or about July 2, 2024, Insurer issued a payment of $12,150.99 for mold remediation and testing performed by X Mold Assessment. On or about July 3, 2024, Insurer issued an additional payment of $1,500 for the reinstallation of the tarp after it sustained damage. On or about August 13, 2024, Complainant and their agents submitted an executed Sworn Statement in Proof of Loss (“SPOL”), dated May 9, 2024, to Insurer. Despite this submission, Insurer failed to acknowledge the SPOL until on or about September 23, 2024. This 41-day delay in communication far exceeds the seven-day requirement under Fla. Stat. 627.70131(1)(a) for responding to claim-related communications. Despite acknowledging the SPOL, Insurer failed to take any substantive action to advance the claim. Instead, Insurer denied the SPOL, citing two reasons: (1) that it was submitted outside the timeframe specified in the policy, and (2) disagreement with the $99,432.81 amount listed on the SPOL. However, Insurer failed to provide any adequate explanation or detailed reasoning for rejecting the SPOL. Rather than addressing the specific figures or discrepancies, Insurer merely referred Complainant back to the original partial-denial letter and estimate. This vague and unsubstantiated response demonstrates a failure to comply with Fla. Stat. 626.9541(1)(i)(3)(f), which mandates that Insurer provide a reasonable explanation in writing for the partial-denial of a claim. Even if the SPOL were to be rejected on procedural grounds, Insurer remains obligated to inform the Complainant of such procedural deficiencies promptly. Under Fla. Stat. 626.9541(1)(i)(3)(e), Insurer is required to affirm or deny coverage of a claim within 30 days of receiving the SPOL. In this case, Insurer exceeded this statutory deadline by an additional 11 days, further delaying the resolution of the claim and leaving the Complainant unclear about the claim’s status. Furthermore, while Insurer acknowledged and ultimately denied the SPOL, it entirely failed to address the estimate prepared by the Public Adjuster. Nowhere in its correspondence prior to litigation has Insurer responded to or evaluated the Public Adjuster’s estimate, which provides a detailed and alternative assessment of the scope of damages, distinct from the field adjuster’s flawed and unqualified evaluation. On or about October 9, 2024, Complainant retained Lawgical for legal representation, a Letter of Representation was sent later the same day. Unsurprisingly, Insurer did not even acknowledge Lawgical’s representation letter after its submission. Insurer’s continued and blatant disregard for communication is a clear violation of Fla. Stat. 626.9541(1)(i)(3)(c) for failure to acknowledge and act promptly upon communications. Insurer’s conduct has not only delayed the resolution of the claim but has also caused undue confusion and frustration for the Complainant. These actions, or lack thereof, underscore Insurer’s failure to handle the claim in accordance with Florida law and its duty for a fair proper investigation of claims. Based on the events described above, it is clear that Insurer conducted an improper investigation to intentionally minimize its liability, contrary to the policy and Florida law’s requirements. Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue, and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds. These tactics are believed to be the general business practices of this Insurer. Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $65,424.75, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy. PLEASE GOVERN YOURSELF ACCORDINGLY.
Comments
User Id Date Added Comment
aabell@kirwanspellacy.com 03-25-2025 March 25, 2025 VIA ELECTRONIC FILING Florida Department of Financial Services Bureau of Consumer Assistance c/o: Civil Remedy Section Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0322 VIA E-SERVICE AT: TBRAZ@THELAWGICALFIRM.COM Tamara Braz, Esq The Lawgical Firm 8865 Commodity Circle Suite 12 Orlano, FL 32819 RE: Pina, C & F v SF Claim No. 5961V934J Policy No. 79-C6-H559-9 DOL: 9/19/2023 CRN No: 805480 Dear Ms. Braz: We represent State Farm Florida Insurance Company (“State Farm”) regarding the claim presented by Felix Pina and Carmen De Pina (hereinafter the “insureds” or “Complainants”), for alleged damages sustained to the property located at 16618 SW 99th Lane, Miami, FL 33196, as a result of alleged damage that allegedly occurred on September 19, 2023. On February 6, 2025, the DFS accepted the filing of a Civil Remedy Notice of Insurer Violation (hereinafter “CRN”) number 805480. This will serve as State Farm Florida Insurance Company’s response to said CRN. The CRN alleges that State Farm Florida Insurance Company violated Florida Statute Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(c), and 626.9541(1)(i)(3)(e), as the basis for filing the instant notice. State Farm Florida Insurance Company explicitly denies the violation of any Florida statute in the evaluation and adjustment of the referenced claim. State Farm Florida Insurance Company explicitly denies the violation of any Florida statute in the evaluation and adjustment of the referred claim. State Farm Florida Company maintains that it has acted promptly, fairly and honestly with its Insureds at all times in the handling of this claim. Further, many of the sections the Complainants cites are wholly inapplicable to this matter on their face. Specifically, State Farm Florida Insurance Company explicitly denies violation of any Florida statute in the evaluation and adjustment of the referenced claim. State Farm Florida Insurance Company denies that it did not, in good faith, attempt to settle the claim and asserts that it has acted fairly and honestly toward its insureds with due regard for their interests. State Farm Florida Insurance Company denies that it failed to adopt and implement standards for the proper investigation of claims. State Farm Florida Insurance Company denies that it failed to acknowledge and act promptly upon communications with respect claims. State Farm Florida Insurance Company denies that it failed to affirm or deny full or partial coverage of claims, and as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon written request of the insured within 30 days after proof of loss statements have been completed. The CRN fails to comply with the very statute the Complainants are seeking to invoke. Contrary to the specific requirements of Section 624.155(3)(b)(4), the CRN fails to identify the specific policy language that is relevant to the purported violation(s), despite State Farm Florida Insurance Company previously providing a copy of the subject policy to the insureds. Section 624.155 states, in pertinent part, as follows: . . . b. notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: * * * 2. The facts and circumstances giving rise to the violation. * * * 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. § 624.155(3)(b)(2)&(4), Fla. Stat. (2015) [emphasis added]. Instead of citing the facts and policy language where the CRN form requires the Complainants to do so, the Complainants merely list facts that would be helpful to the Complainants’ position and fails to include a plethora of additional facts and policy provisions that shed an unwanted light on Complainants’ position. This broad, generic, inaccurate approach to completing a CRN is non-conforming to the requirements of Florida law. State Farm Florida Insurance Company also objects to the CRN, as it lacks sufficient specificity, as required by §624.155, Fla. Stat., in addition to other defects. As filed, the CRN fails to accurately and specifically describe the facts and circumstances of State Farm Florida Insurance Company’s alleged statutory violation. Instead, the insureds’ recitation of “facts” presents mere conclusory statements and offers no support as to the acts and/or omissions purportedly taken by State Farm Florida Insurance Company which substantiate the insureds’ allegations. The Insureds’ assertions are vague, baseless, and contrary to Florida law. Furthermore, the allegations contain sweeping summaries of conversations that purportedly occurred without any support for the same. Section 624.155(2)(d) “requires that the civil remedy notice state with specificity the facts and circumstances giving rise to the violation.” Lane v. Westfield Ins. Co., 862 So.2d 774, 778 (5th DCA 2003). The purpose of a civil remedy notice is to give the insurer one last chance to settle a claim with the Insured, and not to give the Insured a right of action to proceed against the Insurer. Lane, 862 So.2d at 779; see also Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773 (M.D. Fla. 1997) (holding that a claimant must give the Florida Department of Insurance and the insurer sixty days written notice of a violation so that the insurer may cure any violation) and Julien v. United Prop. & Cas. Ins. Co., 46 Fla. L. Weekly D486 (Fla. 4th DCA March 3, 2021). Without such notice, State Farm Florida Insurance Company is unable to cure any alleged defect, if warranted. Instead of citing actual facts and policy language, where the CRN form requires the Complainants to do so, the Complainants provides a vague, inaccurate, and misleading recitation of the facts of this claim, omitting pertinent facts, and misstating others. This approach in completing a CRN is not only non-conforming to the requirements of Florida law, but it also fails to place State Farm Florida Insurance Company on notice as to what the Complainants contend State Farm Florida Insurance Company has or has not done to the insured’s satisfaction. Stripped of its purpose to give State Farm Florida Insurance Company notice of potentially applicable cures, the CRN is entirely deficient with respect to the explicit requirements of Section 624.155 and should be rejected as being non-compliant with the statute. Due to the lack of specificity and other defects, the CRN is invalid and cannot serve as a condition precedent to any action for alleged bad faith under §624.155, Fla. Stat., or otherwise under Florida law. Despite the allegations made by the Complainants, State Farm Florida Insurance Company diligently and thoroughly complied with guidelines throughout its investigation of the alleged loss once it was reported on January 16, 2024. The investigation included but it was not limited to performing inspections that occurred on March 7, 2024. At the time of the inspections, it was determined that there was no evidence of wind or hail related damage and no openings by these causes of loss were created. There was visible deterioration to the roof tiles in the form of chipped/cracked tiles as a result of long-term thermal expansion/contraction, exposure to the elements overtime, and possible foot falls. There was normal wear, tear, and deterioration of the roofing system consistent with the age of the roof. Additionally, the subject homeowners insurance policy does not provide coverage for wear, tear, deterioration, or settling, cracking, shrinking, bulging, or expansion of pavements, patios, foundations (including slabs, basement walls, crawl space walls, and footings), walls, floors, roofs, or ceilings. Based on that, State Farm Florida Insurance Company issued its coverage determination on March 23, 2024, finding that the portions of the reported loss were not covered under the applicable policy of insurance. State Farm Florida Insurance Company denies that it failed to acknowledge and act promptly upon communications with respect claims. Complainants provided a Sworn Statement in Proof of Loss on August 13, 2024 for a claim with a purported date of loss of September 19, 2023 that was reported on January 16, 2024 without any supporting documentation. Upon receipt of the Public Adjuster’s estimate, State Farm was able to evaluate the amount claimed in Plaintiffs’ Sworn Statement in Proof of Loss and therefore any delay in response to same was due to Complainants’ delay in providing claim documents. Additionally, Complainants allege that State Farm Florida failed to acknowledge the Letter of Representation from The Lawgical Firm; however, after the receipt of the Letter of representation, The Lawgical Firm was included on all correspondence; thereby acknowledging representation. State Farm Florida Insurance Company further objects to the CRN, and the CRN is defective, additionally because it neither provides a general description, nor references to the specific policy language at issue in the alleged violations, as required by Florida Statute §624.155(3)(b)4. Rather, the CRN merely uses boilerplate language as to State Farm Florida Insurance Company’s actions, which fails to explain how State Farm Florida Insurance Company was wrong in its assessment of coverage. The subject policy issued by State Farm Florida Insurance Company is governed by the policy’s terms, conditions, and exclusions together with any endorsements. State Farm Florida Insurance Company, being the maker of the policy, is very familiar with its language and what losses are afforded coverage. This CRN response does not waive any such provisions of the policy. Lastly, because no specific facts or remedies are referenced, State Farm Florida Insurance Company cannot be expected to investigate the Complainants’ allegations and determine whether any corrective measures are warranted. As such, the CRN is defective and must be rejected. Section 624.155, of the Florida Statutes sanctions recovery of extra-contractual damage in insurance disputes when the insurance carrier fails to attempt in good faith to settle a claim. The statute requires the Insureds to file a Civil Remedy Notice of Insurer Violation as a condition precedent to the bad faith cause of action. The Statute demands strict compliance and lays out specific notice requirements the Insured’s CRN has to meet for it to be legally sufficient. The filing of a legally sufficient CRN is not only a condition precedent but is essential to the procedural integrity of an action for bad faith. See Allstate Ins. Co. v. Clohessy, 32 F. Supp. 2d 1328 (M.D. Fla. 1998); see also Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000). The statute’s clear and unambiguous standards for proper notice require the claimant to state with specificity the facts and circumstances giving rise to the violation and to reference the policy language relevant to such alleged violations. The CRN alleges State Farm Florida Insurance Company’s statutory violation of Florida Statute Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(c), and 626.9541(1)(i)(3)(e), as the basis for filing the instant notice. However, the CRN (i) fails to reference the proper policy language relevant to such alleged violations; (ii) fails to state with specificity any facts and circumstances giving rise thereto; and (iii) fails to state, with specificity, the cure sought by the insured. The CRN is facially deficient and fails to comply with current Florida case law, as stated above. The purpose behind the notice requirement of the Civil Remedy Statute is to give an opportunity to the insurer to remediate the alleged statutory violation. The statute provides a sixty day cure period during which an insurer may avoid bad faith litigation by (i) paying the contractual amount due under the policy or (ii) by correcting the circumstances giving rise to the violation. The CRN provides no such opportunity to State Farm Florida Insurance Company as the CRN does not specify the circumstances giving rise to State Farm Florida Insurance Company’s alleged violations. The Complainants do not indicate how the cited policy language is relevant to any violations alleged and do not state with specificity any facts or circumstances giving rise to any violation. As such, the Complainants’ CRN does not afford State Farm Florida Insurance Company adequate notice or an opportunity to cure any alleged violation, if warranted. The Insured’s CRN is deficient and should be rejected. State Farm Florida Insurance Company denies any violation of Florida Statute Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(c), and 626.9541(1)(i)(3)(e), State Farm Florida Insurance Company has acted promptly, fairly, in good faith, and in the best interest of the Insured at all times during the claims process. State Farm Florida Insurance Company does not intend by this letter or any aspect of its investigation to waive any of its rights afforded either under the contract of insurance or at law. State Farm Florida Insurance Company explicitly reserves all rights. Sincerely, CHRISTOPHER L.KIRWAN
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