Civil Remedy Notice of Insurer Violations
Login

Filing Number:     805681
Filing Accepted:  2/7/2025
         Print Filing
Complainant
Last/Business Name *  
HELLER / HELLER   First Name   SAMUEL / SARAH
Street Address * 4205 W. AZEELE STREET
City, State Zip * TAMPA, FL 33609
Email Address * SHELLER@OLDERLUNDYLAW.COM; BALMERSJ@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HELLER / HELLER   First Name   SAMUEL / SARAH
Policy # * FPH5368852-02 Claim #* FPI247159
Attorney
Attorney is Applicable
Last Name* PETTINATO First Name * DAVID Initial
Street Address* 1000 W. CASS STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * DPETTINATO@OLDERLUNDYLAW.COM, DJP-PARALEGALS@OLDER
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):* KYMANI ZAMORA, KIMBERLY BAKER, ARIAN RUST, ERICA PILGROM, CHRISTIAN JONES, DIANA RICHARDSON, ESSENCE SPIVEY, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY FLORIDA PENINSULA INSURANCE COMPANY INVOLVED
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Failure to properly investigate claim and with due regard to Insured’s interest
Other : Failure to acknowledge and act promptly to communications regarding claim
* 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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

ADD’L STATUTES VIOLATED §627.70131(2) §627.70131(7)(a) POLICY LANGUAGE The Insureds may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within Florida Peninsula Insurance Company’s Homeowners policy, Policy No. FPH5368852-02, issued to the Insureds including, but is not limited to, the following: Coverage A-Dwelling provisions (FP HO 03 04 23) Coverage B-Other Structures provisions (FP HO 03 04 23) Coverage C-Personal Property provisions (FP HO 03 04 23) Coverage D-Loss of Use provisions (FP HO 03 04 23) - Additional Living Expenses Additional Coverages provisions (FP HO 03 04 23) - Debris Removal - Emergency Mitigation Services - Trees, Shrubs and Other Plants - Glass or Safety Glazing Material - “Fungi”, Mold, Wet or Dry Rot, Yeast or Bacteria - Reasonable Repairs - Ordinance Or Law Limitations on Roof Coverage endorsement (FP HO RCL 06 23) Limited Water Damage Coverage endorsement (FP HO LWD 03 23) The Declarations Page (FPI HO DEC FL 04 23) Loss Payment or Loss Settlement provisions (FP HO 03 04 23) Duties in Event of Loss Policy provisions (FP HO 03 04 23) The insurance policy's definition sections (FP HO 03 04 23) The insurance policy's exclusion of coverage provisions (FP HO 03 04 23) Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insureds for the October 9, 2024, Hurricane Milton and/or hurricane force winds loss.
 
* 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 (“FLORIDA PENINSULA”) has breached this duty by its failure or refusal to acknowledge its Insureds’ claim of loss. FLORIDA PENINSULA has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations as set forth above. FLORIDA PENINSULA has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim for damages. To date, notwithstanding the Insureds’ pleas, FLORIDA PENINSULA has continued to refuse to acknowledge its obligation to acknowledge and pay the full amount of its Insureds’ claim. This complaint is made on behalf of the Insureds, SAMUEL AND SARAH HELLER (“MR. AND MRS. HELLER”). Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155. In consideration of the premium paid to it by MR. AND MRS. HELLER, FLORIDA PENINSULA issued a Homeowners policy, Policy No. FPH5368852-02 (hereinafter referred to as “The Policy”), to MR. AND MRS. HELLER wherein the insurance policy provided coverage for all losses, including Hurricane Milton and/or hurricane force winds, except those losses which were expressly excluded. The policy was in full force and effect at the time the damage occurred as a result of Hurricane Milton and/or hurricane force winds, and the ensuing damages as a direct result thereof, to the insured premises located at 4205 W. Azeele Street, Tampa, FL 33609, on or about October 9, 2024. On or about October 9, 2024, Hurricane Milton, a large and destructive Category 3 storm, struck the state of Florida, bringing heavy rains, hurricane-force winds and tornadoes. Hurricane Milton caused numerous fatalities and complete destruction or extensive property damage to the structures, homes, businesses, and roadways in its path. Millions of people were left without power, while many others were entrapped or forced to seek refuge elsewhere. As a result of the extreme damage and loss of life, the name Milton will never be used again for an Atlantic hurricane. MR. AND MRS. HELLER’S insured property sustained damages to the interior and exterior of the home. On the exterior, their property sustained damages, including but not limited to, the roof system and the property fence. On the interior, MR. AND MRS. HELLER’S insured property sustained damages, including but not limited to, the insulation, drywall, paint, crown molding, etc. in the great room, closet, and bedroom. MR. AND MRS. HELLER timely notified FLORIDA PENINSULA of the damages and opened a claim pursuant to the terms and conditions of the Policy. In response, FLORIDA PENINSULA assigned the claim to its representative to adjust and investigate the loss, as well as a field adjuster to inspect the damages. FLORIDA PENINSULA’S representative visited the insured property and performed a cursory and inadequate investigation of the damaged property. MR. AND MRS. HELLER were unable to be present during the inspection from FLORIDA PENINSULA, but received confirmation from field adjuster Ari Rust, that he performed a full inspection and even pulled back the tarp on their roof and confirmed that he “[could] see into the attic” from the outside and that they would be “pleased” with the estimate provided by FLORIDA PENINSULA. On or about October 28, 2024, FLORIDA PENINSULA submitted a Below Deductible Letter to MR. AND MRS. HELLER, stating that their “insurance policy does not include coverage for damage resulting from flood even if hurricane winds and rain caused the flood to occur” and since the noted damages were less than the deductible, no payment would be made. On October 28, 2024, MR. AND MRS. HELLER communicated with Christian Jones from FLORIDA PENINSULA and requested to speak about the received deficient estimate from FLORIDA PENINSULA. In response, Christian Jones advised that Mr. Rust had not performed a “full inspection” and that one would be required to get a completed investigation of MR. AND MRS. HELLER’S claim. Mr. Jones also stated that MR. AND MRS. HELLER could disregard the Below Deductible Letter, since the investigation was only “partially” completed. In contrast to FLORIDA PENINSULA’S damage estimate, MR. AND MRS. HELLER’S damage estimate from Hunter Claims, LLC. (Hunter Claims), totaled a Dwelling loss of $104,597.97 Hunter Claims estimate demonstrates the full extent of damages sustained to MR. AND MRS. HELLER’S insured property, as detailed above. Following the loss, MR. AND MRS. HELLER retained Jeff Walton to perform mitigation services to their insured property, including installing a temporary tarp on their roof system, removing damaged flooring and drywall, and removing damaged personal property. On October 30, 2024, MR. AND MRS. HELLER communicated with FLORIDA PENINSULA their concerns about the estimate and inconsistencies with Mr. Rust’s verbal comments over the phone during the inspection. In return, MR. AND MRS. HELLER were confirmed by FLORIDA PENINSULA that there was no indication in his notes that the tarp was ever pulled up and that no photographs were taken, despite having received confirmation from Mr. Rust that photographs were taken during the FLORIDA PENINSULA inspection. During the course of the October 30, 2024 conversation with FLORIDA PENINSULA, MR. AND MRS. HELLER were told to communicate with FEMA and could not advise on specific reasons for the estimate total, stating only that FRONTLINE PENINSULA used “discretion” when issuing the claims determination. With regards to MR. AND MRS. HELLER’S claim determination process, FLORIDA PENINSULA has misrepresented the large extent of damages sustained from the loss, and has also failed to provide clear professional communication on damage evaluation and determination to its insureds. To date, MR. AND MRS. HELLER have not received any owed insurance benefits from FLORIDA PENINSULA. To date, MR. AND MRS. HELLER have not received any reinspection offers/requests from FLORIDA PENINSULA. To date, MR. AND MRS. HELLER have not received any settlement offers from FLORIDA PENINSULA. To date, FLORIDA PENINSULA has failed to tender any supplemental insurance benefits. FLORIDA PENINSULA has admitted that MR. AND MRS. HELLER sustained covered damages as a result of the Hurricane Milton and/or hurricane force winds loss that occurred on or about October 9, 2024 but has denied tendering all owed insurance benefits to MR. AND MRS. HELLER. Pursuant to Florida Statute §626.9541(1)(i)(4), FLORIDA PENINSULA is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after FLORIDA PENINSULA received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). As FLORIDA PENINSULA has failed to do so, FLORIDA PENINSULA has wrongfully denied coverage. Since the beginning of the claim, FLORIDA PENINSULA has engaged in a pattern of delay, denial, and reckless disregard for MR. AND MRS. HELLER’S rights. The actions of FLORIDA PENINSULA listed herein have been continuing in nature and given the totality of the circumstances, which includes FLORIDA PENINSULA’S adjustment, actions and/or omissions post the filing of this CRN. MR. AND MRS. HELLER contend that given the past experience in this matter with FLORIDA PENINSULA, it is reasonably foreseeable that FLORIDA PENINSULA’S current actions will extend to its entire conduct in the handing of their claim, including the acts or omissions of FLORIDA PENINSULA and/or its representatives, until the final resolution of their claim. As such, MR. AND MRS. HELLER contend adequate notice has been given should FLORIDA PENINSULA’S actions and violations listed herein continue after the expiration of this notice. FLORIDA PENINSULA has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards MR. AND MRS. HELLER, and has failed to take into account the information and evidence provided that contradict its decisions. FLORIDA PENINSULA’S conduct has been reckless and unfair to MR. AND MRS. HELLER, and has caused and continues to cause additional damages throughout the property. This is evidenced by the delay in paying the claim and the failure of FLORIDA PENINSULA to evaluate the claim in total. To date, FLORIDA PENINSULA has failed and/or refused to provide MR. AND MRS. HELLER with all the necessary insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that MR. AND MRS. HELLER have sustained covered damages to their insured property. As FLORIDA PENINSULA must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. FLORIDA PENINSULA is bound to conduct itself with the utmost good faith for the benefit of MR. AND MRS. HELLER. However, FLORIDA PENINSULA has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, FLORIDA PENINSULA has looked for ways not to pay the claim in full, or pay the claim at all, and these actions have been to the detriment of MR. AND MRS. HELLER. 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 manner prejudicial to MR. AND MRS. HELLER. FLORIDA PENINSULA is using either untrained or improperly trained adjusters in connection with this claim. FLORIDA PENINSULA should have been adjusting the loss with MR. AND MRS. HELLER but instead, it was looking for ways not to pay the claim at all, or pay the claim in full. If FLORIDA PENINSULA handles all the claims in the manner in which MR. AND MRS. HELLER’S claim was adjusted, then it is improperly handling all claims. FLORIDA PENINSULA has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, FLORIDA PENINSULA was to timely tender undisputed insurance benefits to MR. AND MRS. HELLER. 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 MR. AND MRS. HELLER during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. 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 security against a contingent loss. Florida Statute §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 MR. AND MRS. HELLER 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 MR. AND MRS. HELLER 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 MR. AND MRS. HELLER is wrongful conduct. Furthermore, MR. AND MRS. HELLER contend that FLORIDA PENINSULA’S adjusters and/or representatives financially benefit by such wrongful conduct. It is clear that FLORIDA PENINSULA’S adjusters have also failed to adhere to insurance industry rules and guidelines when adjusting a first party claim. It is also evident that FLORIDA PENINSULA violated the Florida unfair claims practices, the adjuster’s ethical code of conduct, and acted irresponsibly in the handling of its Insureds’ claims. In this case, MR. AND MRS. HELLER paid a hefty premium for a service, the service is called claims adjusting (I encourage you to read the book titled, “The Claims Environment” written by James J. Markham, Kevin M. Quinley, and Layne S. Thompson-this book is taught in every first year AIC course). The claim professional must dispense his or her knowledge and skill for the benefit of society. The general public expects claims representatives to pay all legitimate claims promptly and fairly. The claim professional must harness all of his or her knowledge and expertise to accomplish the objectives of the claim function. He or she must also adhere to the highest degree of ethical conduct. In addition to interacting with other insurance personnel and service providers in a professional manner, the claims professional must deal with public’s and regulator’s expectations. Insurance Companies provide such a vital and necessary service to society that the selling and servicing of insurance is imbued with a public trust. James J. Markham, Kevin M. Quinley, Layne S. Thompson, “The Claims Environment”, Insurance Institute of America, 1st ed., 1993. Accordingly, FLORIDA PENINSULA has a contractual and statutory obligation to investigate all possible bases which might support MR. AND MRS. HELLER’S claim and cannot deny a claim without thoroughly investigating the foundation for its denial or basis for withholding insurance benefits. FLORIDA PENINSULA violated its obligations here. - FLORIDA PENINSULA has a contractual and statutory obligation to make a perfunctory investigation, not ignoring evidence that would support MR. AND MRS. HELLER’S claim. FLORIDA PENINSULA violated its obligations here. - FLORIDA PENINSULA has a contractual and statutory 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 violated its obligations here. - FLORIDA PENINSULA has a contractual and statutory obligation not to deny the claim based on standards known to be impermissible or on an interpretation contrary to established law. FLORIDA PENINSULA violated its obligations here. These actions and violations were either done intentionally or as the result of FLORIDA PENINSULA’S failure to adopt and implement the proper standards of the investigation and adjustment of claims. Overall, FLORIDA PENINSULA’S investigation of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law. MR. AND MRS. HELLER have done everything legally requested by FLORIDA PENINSULA to date. To cure the violations set forth in this Civil Remedy Notice, FLORIDA PENINSULA must now agree to acknowledge its duties and obligations under the law in adjusting its Insureds’ claim, and tender rightfully owed insurance benefits to return MR. AND MRS. HELLER to their pre-loss condition. Further, to cure the violations set forth in this Civil Remedy Notice, MR. AND MRS. HELLER hereby request that FLORIDA PENINSULA tender at this time, or prior to the expiration of the statutory cure period, the amount of MR. AND MRS. HELLER’S damage estimate and demand which accurately reflects the true nature and extent of MR. AND MRS. HELLER’S damages. Therefore, FLORIDA PENINSULA should tender $100,023.97 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time. Although MR. AND MRS. HELLER have made a demand for payment in the amount of $100,023.97 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible) and have provided FLORIDA PENINSULA with all the necessary documentation in support thereof, they may still be willing to consider and to potentially accept any reasonable counter-offer made by FLORIDA PENINSULA. Therefore, if FLORIDA PENINSULA is not in agreement with MR. AND MRS. HELLER’S reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, MR. AND MRS. HELLER hereby request that FLORIDA PENINSULA now make a reasonable counter-offer before the expiration of the cure period. MR. AND MRS. HELLER still hope that their claim can be resolved amicably. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §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 MR. AND MRS. HELLER may mitigate their damages and to put them back into the position they were in prior to loss as quickly as possible. FLORIDA PENINSULA breached this duty. This notice is given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155, including any and all bad faith/extra contractual, should FLORIDA PENINSULA fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, MR. AND MRS. HELLER will consider the allegations contained herein “cured” if FLORIDA PENINSULA, without any requirement for a release: (1) Immediately tenders the amount of MR. AND MRS. HELLER damage estimate in the amount of $107,047.97 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damages to the Dwelling / Other Structures; (2) Agrees to reimburse MR. AND MRS. HELLER for their expenses incurred by having to retain a public adjuster to present their claim; and (3) Immediately tenders the amount of statutory interest due and owing to MR. AND MRS. HELLER pursuant to Florida Statute §627.70131(5)(a). (4) Immediately provides MR. AND MRS. HELLER with the documentation FLORIDA PENINSULA has used and/or continues to contend, supports the claim determination made by FLORIDA PENINSULA in the adjustment of MR. AND MRS. HELLER’S claim. Specifically, FLORIDA PENINSULA must provide MR. AND MRS. HELLER with its claim estimate(s), supporting photographs and/or videos, as well as any and all reports of any expert(s) or other individuals retained on behalf of FLORIDA PENINSULA upon which FLORIDA PENINSULA has relied on in reaching and/or further supporting its coverage determination in MR. AND MRS. HELLER’S claim. MR. AND MRS. HELLER continue to remain open to a fair and reasonable settlement offer from FLORIDA PENINSULA in an effort to avoid additional delay, costs and expenses, and hereby request the same prior to the expiration of the statutory “cure” period. MR. AND MRS. HELLER have provided FLORIDA PENINSULA with all necessary estimates, documentation, etc. in support of the claim. FLORIDA PENINSULA must act fairly and honestly in its response to MR. AND MRS. HELLER’S request for a prompt, fair and reasonable settlement offer and resolution of the claim.
Comments
User Id Date Added Comment
atyson@conroysimberg.com 04-08-2025 CRN RESPONSE We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Florida Peninsula Insurance Company’s Named Insureds, Samuel Heller and Sarah Heller, which was accepted by the Department of Financial Services on February 7, 2025, and assigned Filing No. 805681. The CRN revolves around a claim (FPI247159) filed for alleged damage from a windstorm, named Hurricane Milton, that occurred on October 9, 2024 at the Insureds’ single-family residence located at 4205 W Azeele Street, Tampa, Florida 33609. The home was built in 1961 and is comprised of a shingle roof that was installed in 2015. At the time of loss, the Insureds’ home was covered under an HO3 Policy, Policy number FPH5368852-02, issued by Florida Pen-insula Insurance Company (“The Company”). At the outset, it should be stated that the CRN is defective and does not conform with the requirements of filing a CRN as it contains inaccurate factual allegations, lacks the required specificity and does not provide an opportunity for the Company to reasonably respond to the alleged violations contained in the CRN. The CRN merely contains conclusory reasons for the Notice, such as failing to settle claims in good faith, failing to implement standards for the proper investigation, and failing to acknowledge and act promptly upon communications, to name a few. For example, the Notice alleges that the Company violated the following statutory provisions of Florida Statutes §624.155: • §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all other 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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under firstparty property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). The CRN fails to identify specific facts as related to the broad and conclusory al-legations. 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). Notwithstanding, the Company explicitly denies violations of any applicable Florida Statute in the adjustment of the referenced claims. The Company specifically denies that it has not attempted in good faith to settle the Insured’s claim when under all the circumstances it could and should have done so and it denies that it has failed to act fairly and honestly toward its Insured’s interests. Moreover, the Company specifically denies that it refused to properly investigate the claim or refused to tender all insurance proceeds without waiver of its objections, rights and defenses, the Company 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, and wishes to dispel even the inference of any violation, and reiterates below the reasons which clearly show the proper handling of the Insured’s claim. Additionally, the Civil Remedy Notice demands “cures” for the alleged defects that are improper under Florida case law. In Talat Enter., Inc., v. Aetna Cas. And Sur. Co., 753 So.2d 1278, 1281 (Fla. 2000), the Supreme Court of Florida held that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due to an insured. As a result, Florida Peninsula Insurance Company objects to the CRN as it is defective and should be rejected. In order to understand the deficiencies of this Notice, however, and reserving all objections to the subject CRN, the background of this case is necessary. On October 10, 2024, the insureds reported this Hurricane Milton claim as having occurred on October 9, 2024. The insureds stated they did not know if the house was livable and had no idea about roof damage as they had evacuated for the storm. It is important to note that from the start, Florida Peninsula Insurance Company (the “Company”) communicated with its Insureds and/or their representatives on a regular basis. In fact, when the claim was reported on October 10, 2024, a first notice of loss letter acknowledging the claim was immediately sent out to the insureds advising the homeowners of their Bill of Rights as Insureds, and their pre-suit mediation opportunities. Further, later in the claim adjustment process, the Insureds were advised of those same rights again, so it was very clear that the Insureds were informed of what they could do to protect themselves under the circumstances should they disagree with the Carrier’s handling and decision. Upon reporting of the loss, the Company assigned the claim to a field adjuster (the “FA”). On October 14, 2024, the FA conducted an inspection of the subject property. The FA carefully assessed and evaluated the claimed damage, which included a thorough inspection of the roof, exterior, and interior of the property. By letter dated October 28, 2024, a coverage determination was issued wherein the Insureds were advised that the policy of insurance did not include coverage for damage resulting from flood even if hurricane winds and rain caused the flood to occur, and, without separate flood insurance coverage, they may have uncovered losses caused by flood. The Company further advised that based on the estimate the damage to the property was less than the insureds’ contractual deductible which was $14,774.00. The Company provided the insureds with its estimate, statement of loss, and an excerpt detailing the applicable policy language clarifying the Company’s decision. The insured then retained counsel who provided a letter of representation on November 8, 2024. Counsel then filed a Notice of Intent to Initiate Litigation on February 7, 2025 which contained a demand in the amount of $86,481.00. The Company responded to the NOIL by letter dated February 12, 2025. Counsel then filed the Civil Remedy Notice with the Department on behalf of the Insureds on February 7, 2025. The Insureds’ counsel complains that there is a disagreement as to scope and pricing in this case, among other items. While that might be true, that does not rise to the level of a statutory violation, it is merely a disagreement with the value of the loss. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. Florida Peninsula Insurance Company has communicated with its Insureds and their representatives as required. Florida Peninsula Insurance Company has inspect-ed the loss and damages thoroughly and given a thorough assessment of its findings and conclusions made. The fact that Florida Peninsula Insurance Company was not in agreement with the position of the Insureds or their representatives and the esti-mates prepared on their behalf, does not rise to the level of statutory violations. Certain-ly, as is noted above through the chronology of this loss, an appropriate claims han-dling procedure was in place to give due consideration to the claim. As demonstrated above, the Company has, thus far, undertaken a thorough ad-justment process and investigation, and the decision that it has made as to what is compensable and what is not has been amply explained to the Insureds. The Compa-ny has, at all times, acted fairly and promptly toward its Insureds and with full regard to their interests, and has complied with its obligations in this claim process. Any further information which may be required is available upon request.
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