Civil Remedy Notice of Insurer Violations
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Filing Number:     806161
Filing Accepted:  2/10/2025
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Complainant
Last/Business Name *  
RICHARD GROUP, LLC   First Name  
Street Address * 2850 HANSON ST
City, State Zip * FORT MYERS, FL 33916
Email Address * ROLON@INFINITEPOOLFINISHES.COM
Complainant Type: * Insured
Insured
Last/Business Name*   RICHARD GROUP, LLC   First Name  
Policy # * FSF16405462 001 Claim #* KY22K2932336
Attorney
Attorney is Applicable
Last Name* O'NEIL First Name * JONATHAN Initial
Street Address* 203 FORT WADE ROAD, SUITE 260
City, State Zip* PONTE VEDRA , FLORIDA 32081
Email Address * JONATHAN@WOOLSEYMORCOM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   WESTCHESTER SURPLUS LINES INSURANCE COMPANY
NAIC Company Code 10172
 
Name of individual responsible for violation (if any):* LUCINDA MILLER (FLA. ADJ. LICENSE #W426510) AND ROBERT JUNE
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Other : Wrongful claim denial
Unfair Trade Practice
Other : Unfair claim settlement practices
Other : Unreasonable investigation
Other : Failure to act on claim
Other : Failure to conduct a reasonable investigation based on available information
Other : Failure to maintain proper complaint handling procedures
Other : Misrepresenting the insurance policy provisions to the insured
Other : Misrepresenting Florida statutory provisions to the insured
Other : Misrepresenting facts to the insured
Other : Failure to acknowledge and act promptly upon communications with respect to claims
Other : Denying claims without conducting reasonable investigations based upon available information
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(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.
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.
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.

BUILDING AND PERSONAL PROPERTY COVERAGE FORM **** A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. **** CAUSES OF LOSS – SPECIAL FORM A. Covered Causes Of Loss When Special is shown in the Declarations, Covered Causes of Loss means direct physical loss unless the loss is excluded or limited in this policy. **** [I]f an excluded cause of loss that is listed in 2.d.(1) through (7) results in a "specified cause of loss" or building glass breakage, we will pay for the loss or damage caused by that "specified cause of loss" or building glass breakage. **** [I]f an excluded cause of loss that is listed in 3.a. through 3.c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. **** 4. Additional Coverages a. Debris Removal (1) Subject to Paragraphs (2), (3) and (4), we will pay your expense to remove debris of Covered Property and other debris that is on the described premises, when such debris is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. **** e. Increased Cost Of Construction (1) This Additional Coverage applies only to buildings to which the Replacement Cost Optional Coverage applies. (2) In the event of damage by a Covered Cause of Loss to a building that is Covered Property, we will pay the increased costs incurred to comply with the minimum standards of an ordinance or law in the course of repair, rebuilding or replacement of damaged parts of that property, subject to the limitations stated in e.(3) through e.(9) of this Additional Coverage. (3) The ordinance or law referred to in e.(2) of this Additional Coverage is an ordinance or law that regulates the construction or repair of buildings or establishes zoning or land use requirements at the described premises and is in force at the time of loss. **** Also refer to: Coverage A provision, coverage B provision, coverage C provision, coverage D provision, all additional coverages provisions, all coverages provided by endorsement or rider, the declarations page, loss payment or settlement provision, duties in event of loss policy provision, all terms and conditions of section I of the insurance policy, the insurance policy definitions section, the insurance policy‘s exclusion of coverage provisions, all insurance policy provisions that provide coverage to the insured property, and all policy provisions.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

624.155(1)(a)(1) – violating 626.9541(1)(i) 626.9541(1)(a)(1) -- misrepresenting the terms of an insurance policy. 626.9541(1)(i) -- unfair claim settlement practices. Facts of the case: Westchester Surplus Lines Insurance Company (“WESTCHESTER”) has committed the following in handling the insured’s claim: 1) failure to pay benefits owed; 2) failure to act in due diligence and good faith to resolve claims; 3) placing the financial interest of the insurer before that of the policy holder and claimant; 4) failure to properly train, evaluate, and manage adjusters retained to represent the policies and procedures of WESTCHESTER; 5) looking for ways to delay benefit payments and otherwise “low ball” or “stone wall” claims; 6) looking for ways to deny the insured’s claim; 7) looking for ways to reduce recovery to the insured; 8) failure to perform a reasonable investigation; 9) misrepresenting Florida statutory provisions to its insured; 10) misrepresenting insurance policy provisions to the insured; 11) WESTCHESTER has failed and refused to acknowledge coverage and promptly pay the benefits due and owed to the insured; 12) the reasons for this may be attributed to improper training, supervision, and/or motivation of outside adjusters and claims supervisors to promptly and fairly adjust and pay full benefits available to the insured. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because a proper investigation and full and prompt payment for the loss is not occurring. In Florida, the work of adjusting insurance claims engages the public trust. WESTCHESTER has breached this duty by its adjustment of the insured’s claim of loss. WESTCHESTER has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in violations as set forth above. WESTCHESTER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages. Despite the insured’s timely notification to WESTCHESTER of their insurance claim, WESTCHESTER has failed and refused to acknowledge the covered loss and pay all amounts due and owing to the insured under the policy of insurance. WESTCHESTER has failed to promptly settle the insured’s insurance claim, when the obligation to settle the claim had become reasonably clear, under one portion of the insurance, in order to influence settlements under other portions of the insurance policy coverage. Despite the insured’s pleas otherwise, WESTCHESTER has failed and refused to acknowledge its obligation to tender all insurance proceed monies due and owing the insured or assist the insured in mitigation of the damages. In exchange for a premium paid by the insured, WESTCHESTER issued the subject insurance policy which provided coverage for the insured property from March 1, 2022 through March 1, 2023 for “direct physical loss unless the loss is excluded or limited in this policy.” As such, the subject all-risk Policy contains coverage for all direct physical losses to the insured property unless the loss is specifically and unambiguously excluded from coverage by the Policy. On or about September 28, 2022, the insured property suffered a windstorm loss (Hurricane Ian), and the insured immediately submitted a claim to WESTCHESTER for property damage, i.e., storm, wind, rain, and water intrusion damages throughout the insured property. Hence, the insured suffered a substantial loss regarding the real property and continue to suffer such loss. Having suffered such substantial damage, the insured promptly notified WESTCHESTER of the loss in an effort to mitigate the current damage and prevent the exacerbation of any additional losses. The desired result did not follow. WESTCHESTER since being presented the Insured’s claim has misrepresented policy provisions to avoid paying the insured what they are owed under the policy. Ultimately, WESTCHESTER has failed and refused to properly settle the insured’s claim in good faith. The insured have requested that WESTCHESTER conduct an investigation, admit coverage, and pay damages; WESTCHESTER has failed and refused to do so. In short, WESTCHESTER has failed to handle its insured’s claim in good faith in violation of Fla. Stat. 624.155(1)(b)(1), 624.155(1)(b)(3), and 626.9541(1)(i). Based upon WESTCHESTER’s investigation and property inspection, which confirmed windstorm damages, WESTCHESTER nevertheless sent correspondence to the insured dated December 29, 2022, signed by WESTCHESTER’s adjuster, Lucinda Miller (Fla. Adj. License #W426510) confirming partial coverage, denying the remainder, issuing partial payment for only $241,875.29, and failing and refusing to pay all amounts due and owing for the loss. In regard to insurance contracts, a specific refusal to pay a claim is the breach which triggers the cause of action. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. State Farm Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991) (finding that a breach of contract takes place at the moment the insurance company refuses to pay a claim). Therefore, WESTCHESTER breached the Policy. Moreover, WESTCHESTER’s argued exclusions and/or limitations to coverage are devoid of anti-concurrent causation language. Thus, “coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause.” Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694, 699 (Fla. 2016). In addition, under the Policy, any ensuing loss to property not excluded or excepted in this policy is covered. Hence, there are a myriad of coverages under the Policy that would provide coverage for the loss. Nevertheless, WESTCHESTER failed and refused to acknowledge the covered loss and pay all amounts due and owing for the loss. Therefore, WESTCHESTER breached the Policy. On June 21, 2023, following additional investigation, WESTCHESTER sent correspondence to the insured signed by WESTCHESTER’s adjuster, Lucinda Miller (Fla. Adj. License #W426510) and reaffirmed its prior coverage determination and partial denial. As such, WESTCHESTER failed and refused to acknowledge the covered loss and pay all amounts due and owing for the loss. Therefore, WESTCHESTER breached the Policy. Concerned with the accuracy of WESTCHESTER’s coverage denial, and given the extensive nature of the physical damage, the insured retained a consulting licensed contractor, Tom Gannon, with LSC Construction Consultants, LLC (“LSC”), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on his investigation, Mr. Gannon concluded that a windstorm (Hurricane Ian) on or about September 28, 2022, caused damage throughout the exterior of the property (particularly the roof warranting replacement), including wind-created openings, which allowed wind and rain to intrude into the interior causing additional damage. Moreover, Mr. Gannon determined that at least $640,901.76 worth of repairs would be required to return the property to its pre-loss condition as a result of the windstorm loss. Nevertheless, WESTCHESTER failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, WESTCHESTER breached the Policy. On February 10, 2025, the insured sent correspondence to WESTCHESTER enclosing the Sworn Statement in Proof of Loss, the supporting LSC report outlining the cause, scope, and cost of the loss along with other supporting documents, the Notice of Intent to Initiate Litigation, and requested WESTCHESTER to reconsider its coverage denial. To date, WESTCHESTER has failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, WESTCHESTER breached the Policy. As such, WESTCHESTER’s coverage denial is a blatant misrepresentation of the available coverages under the Policy in direct violation of Fla. Stats. 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is nothing more than a mere pretext to wrongfully deny and delay this claim. As a result, WESTCHESTER has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of effecting settlement of the insured’s claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Fla. Stat. § 626.9541(1)(i)(2). Further, WESTCHESTER is in violation of Florida statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Fla. Stat. 626.9541(1)(i)(3)(d) by denying the insured’s claim without conducting a reasonable investigation based upon available information. In summary, the insured’s loss is clearly covered by the terms of the policy of insurance with WESTCHESTER. However, WESTCHESTER chose to deny coverage for the insured’s loss. Despite clear evidence that the damages were covered and caused by a covered peril, the claim was denied. To date, WESTCHESTER continues to deny the insured and its insured full indemnity for the claim. While WESTCHESTER refuses to honor this claim, a jury in Lee County will likely do what WESTCHESTER has refused; exercise the benefit of doubt in favor of the insured in finding full coverage for this loss. Indeed, the insured will undoubtedly meet the burden of proof at trial, under the WESTCHESTER all-risk policy, to show that, while WESTCHESTER provided insurance coverage, damage occurred to the insured property. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). With the data presented within the WESTCHESTER’s investigation and LSC’s investigation, WESTCHESTER’s burden to demonstrate by the greater weight of the evidence that all the physical damage to the insured property was caused solely by excluded perils under the policy and not in combination with a covered peril has not and cannot be met. See Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694 (Fla. 2016). Despite clear indicators of covered damage, WESTCHESTER nevertheless inexplicably denied the insured’s claim. As of today, WESTCHESTER has failed and refused to inform the insured of their rights under the policy of insurance and Florida statutes, has improperly delayed the insured’s claim, has wrongfully denied the insured’s claim, and has failed and refused to adequately indemnify the insured for the loss and defiantly continues to do so. Indeed, from the time of receiving the claim, WESTCHESTER has purposely and maliciously delayed in adjusting the subject claim in an effort to either avoid paying the claim altogether or, at the very least, avoid paying the full extent of the loss. Notably, under Florida law, “[t]he filing of a lawsuit does not extinguish the insurer’s obligations under the policy to adjust and pay the claim.” Tristar Lodging, Inc. V. Arch Specialty Ins. Co., 434 F. Supp. 2d 1286, 1289 (M.D. Fla. 2006). To date, the insured has made a good faith effort to comply with all of the requirements under the subject policy of insurance, and it is only fair that WESTCHESTER do the same. Yet, that is not the case. The insured feels that the insured property is a valuable asset, and, by continuously delaying the proper handling of this claim, WESTCHESTER is putting the insured property at risk. As a responsible property owner, the insured purchased insurance to protect the property, paid all of the premiums, and has kept up to date with the responsibilities under the policy. Yet, when the insured needed to rely on the insurance because of this unforeseen loss, WESTCHESTER turned its back and delayed and wrongfully denied coverage that the insured are rightfully owed. Ultimately, WESTCHESTER has failed and refused to properly investigate the loss. The insured has requested that WESTCHESTER admit coverage and pay damages, WESTCHESTER has failed and refused to do so, and continues to refuse to fully indemnify the insured for the loss and pay the amounts necessary to properly repair the insured’s property, despite knowing it is required to do so. In short, WESTCHESTER has failed to handle its insured’s claim in good faith. In Florida, the work of adjusting insurance claims engages the public trust; WESTCHESTER has breached this duty by its insufficient adjustment of the insured’s claim. WESTCHESTER 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 set forth above. WESTCHESTER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages. Florida statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a 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 to put them back into the position they were prior to loss as quickly as possible. WESTCHESTER breached this duty. The actions taken by WESTCHESTER in the handling / adjustment of the insured’s claim were willful, wanton, and with complete disregard for the rights of its insured and occur with such a frequency as to indicate a general business practice and are in violation of Fla. Stat. 624.155 and 626.9541. WESTCHESTER’s actions amount to but are not limited to the following: 1. Claim delay 2. Wrongful claim denial 3. Unfair trade practice 4. Unfair claim settlement practices 5. Unreasonable investigation 6. Failure to act on claim 7. Failure to conduct a reasonable investigation based on available information 8. Failure to maintain proper complaint handling procedures 9. Misrepresenting the insurance policy provisions to the insured 10. Misrepresenting Florida statutory provisions to the insured 11. Misrepresenting facts to the insured 12. Failure to acknowledge and act promptly upon communications with respect to claims 13. Denying claims without conducting reasonable investigations based upon available information 14. 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. 15. 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. 16. Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 17. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 18. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. Therefore, to cure the defects outlined in this civil remedy notice, WESTCHESTER must: (1): Admit full coverage for the insured’s loss; and (2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy. A copy of this form submitted to the FDFS has been emailed and/or uploaded and also printed out and mailed to the following parties providing them notice of the filing of this civil remedy notice: Westchester Surplus Lines Insurance Company P.O. Box 4700 Chesapeake, VA 23327-4700 lucinda.miller@chubb.com ChubbClaimsFirstNotice@chubb.com examinermail@chubb.com
Comments
User Id Date Added Comment
jonathan@woolseymorcom.com 12-19-2025 Withdrawn.
Taylor.davis@clydeco.us 04-11-2025 Dear Mr. O'Neil, This firm represents Westchester Surplus Lines Insurance Company ("Westchester") in connection with the above-referenced matter, and we write on its behalf. Please accept this letter as Westchester's response to the Civil Remedy Notice of Insurer Violations, Notice No. 806161 (the "CRN"), filed by your office on or about February 10, 2025, on behalf of Richard Group, LLC ("Richard Group"). We understand the CRN relates to claim number KY22K2932336 arising from alleged wind damage that occurred on or about September 28, 2022, due to Hurricane Ian (the "Loss" or "Claim"). We further understand that the claimed damages relate to the commercial property located at 2850 Hanson St., Fort Myers, FL 33916 (the "Property"). The content of this response was also sent to you via email and US mail on April 11, 2025. The Policy: Westchester issued policy number FSF16405462 001 to Richard Group as the named insured for the policy period of March 1, 2022 to March 1, 2023 (the "Policy"). The Policy is a written document, the terms and conditions of which speak for themselves. The Policy contains a Windstorm or Hail Deductible Form, which provides for a 5% deductible applied separately to each building or structure; the contents in or on each building or structure; Personal Property in the open; Business Income/Extra Expense and/or Rental Value; and all other covered items. The Policy also contains an Actual Cash Value Roof Limitation Form, which provides that only Actual Cash Value is provided for covered damage to roofing at the Property, rather than Replacement Cost. The Loss and Investigation: Richard Group claims to have suffered a loss resulting from Hurricane Ian, which impacted the Property on or around September 28, 2022. After being notified of the Claim on October 5, 2022, Westchester acknowledged the Claim the next day, on October 6, 2022, and took prompt action to begin its investigation, retaining Crawford Global Technical Services ("Crawford") to assist with the Claim. Crawford inspected the Property on October 13, 2022, and their inspection revealed "damage to the TPO membrane roofing, metal roofing, sheathing, gutter and fascia damage. The AC Unit was also damaged by the storm. Additionally, the adjuster also noted chain link fencing was damaged." • THE FIRST POSITION LETTER As Richard Group acknowledged in the CRN, Westchester completed its investigation within three months of the date of loss and notified Richard Group of its findings based on Crawford's report and final estimate. See CRN, page 4 of 7. Given its findings, Westchester set forth its coverage position in a letter dated December 29, 2022 (the "First Position Letter"). With respect to the damage to the roof, Westchester first explained the basis for the $100,000 deductible due to the Windstorm or Hail Deductible Form, which is 5% of $2,000,000. Next, due to the Actual Cash Value Roof Limitation Form, Westchester noted that the Actual Cash Value was $341,875.29, subject to the above-referenced $100,000 deductible for a net payment of $241,875.29. Notably, this was a claim payment and was not an "offer of settlement." With respect to the damaged fencing discovered, Westchester advised that the Policy contains an exclusion for fencing, as follows: 2. Property Not Covered Covered Property does not include: … q. The following property while outside of buildings: … (2) Fences, radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers, trees, shrubs or plants (other than trees, shrubs or plants which are "stock" or are part of a vegetated roof), all except as provided in the Coverage Extensions. Thus, Westchester advised that there was no coverage for the fencing as it is listed as "property not covered." Finally, Westchester advised that any applicable Building Code Upgrades coverage was limited, and required the work to be actually and timely performed pursuant to the following provision: 4. Additional Coverages … e. Increased Cost of Construction … (6) The most we will pay under this Additional Coverage, for each described building insured under this Coverage Form, is $10,000 or 5% of the Limit of Insurance applicable to that building, whichever is less. If a damaged building is covered under a blanket Limit of Insurance which applies to more than one building or item of property, then the most we will pay under this Additional Coverage, for that damaged building, is the lesser of $10,000 or 5% times the value of the damaged building as of the time of loss times the applicable Coinsurance percentage. The amount payable under this Additional Coverage is additional insurance. (7) With respect to this Additional Coverage: (a) We will not pay for the Increased Cost of Construction: (i) Until the property is actually repaired or replaced at the same or another premises; and (ii) Unless the repair or replacement is made as soon as reasonably possible after the loss or damage, not to exceed two years. We may extend this period in writing during the two years. ... Westchester advised Richard Group that it would need to submit a copy of the final invoice showing the upgrade was installed. To date, Westchester has received no such documentation. Westchester's calculation of the covered loss was provided as follows: $ 384,776.82 Building Replacement Cost (RCV) <$39,824.99> Less Non-Recoverable Depreciation -Roof Coverings ($ 3,076.54) Less Recoverable Depreciation – non roof related items $ 341,875.29 Actual Cash Value (ACV) <$100,000> Less 5% Wind Deductible $ 241,875.29 Net Indemnity Payment Westchester immediately issued payment in the amount of $241,875.29 and received no further communication from Richard Group regarding its coverage position set forth in its First Position Letter. • THE MAY 5 RESERVATION OF RIGHTS LETTER Over seven months after the reported date of loss, on May 4, 2023, Richard Group claimed additional damage to the Property, stating that "the building has shifted and cracked and as you can see water is seeping through the walls." On May 5, 2023, the very next day, Westchester sent Richard Group a letter confirming receipt of the notice of supplemental damages relating to the Loss and agreeing to reinspect the Property to evaluate Richard Group's claim for additional damages. In the May 5th letter, Westchester indicated that it was reserving all rights and set forth Policy provisions that appeared pertinent given the information provided in the May 4, 2023, correspondence reporting additional damage, including the following: B. Exclusions 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. … b. Earth Movement … (4) Earth sinking (other than sinkhole collapse), rising or shifting including soil conditions which cause settling, cracking or other disarrangement of foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil and the action of water under the ground surface. … g. Water (1) Flood, surface water, waves (including tidal wave and tsunami), tides, tidal water, overflow of any body of water, or spray from any of these, all whether or not driven by wind (including storm surge); (2) Mudslide or mudflow; (3) Water that backs up or overflows or is otherwise discharged from a sewer, drain, sump, sump pump or related equipment; (4) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings; or … 2. We will not pay for loss or damage caused by or resulting from any of the following: … f. Continuous or repeated seepage or leakage of water, or the presence or condensation of humidity, moisture or vapor, that occurs over a period of 14 days or more. … C. Limitations The following limitations apply to all policy forms and endorsements, unless otherwise stated: 1. We will not pay for loss of or damage to property, as described and limited in this section. In addition, we will not pay for any loss that is a consequence of loss or damage as described and limited in this section. … c. The interior of any building or structure, or to personal property in the building or structure, caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; … Following the letter, Westchester hired Crawford, along with Professional Engineer Richard E. Stogran with YA Engineering Services, LLC ("YAES"), to reinspect the Property on May 25, 2023, for the purpose of evaluating the additional damages. Richard Group's CEO, Rolon Richard, was present for the reinspection. Following the inspection, YAES issued a report dated June 15, 2023. In its report, YAES stated that the inspection "did not reveal any indication of building movement related to wind pressure." Richard Group was provided a copy of the YAES Report, but we briefly set forth YAES's conclusions and additional findings from the YAES Report below: 1. The building did not experience any damaging movement of exterior CMUs, roof framing, or columns during Hurricane Ian. Likewise, no openings were created in the exterior walls due to wind. 2. Water infiltration is occurring at the roof-to-wall connections due to deficiencies in the installations of the TPO membrane and flashing along the eaves, which has afforded potential pathways of entry for wind-driven rains. 3. It is likely that water infiltration has been occurring at the roof eaves prior to the installation of the new roof covering as well, evidenced by dark staining on the interior surfaces of the CMU walls. 4. Dark discoloration of wood planks at the ceiling above the first-level bathroom are a result of the aforementioned water infiltration occurring along the roof eave. 5. The vinyl flooring in the first-level office appeared to have been exposed to water. However, recent renovations may have obfuscated the source of the water exposure, which may also be a result of the water infiltration occurring at the roof-to-wall interface. Nonetheless, the water exposure was not a result of any openings in the CMU wall caused by wind. • THE SECOND POSITION LETTER Based on the YAES Report, Westchester issued its second coverage position to Richard Group on or about June 21, 2023 ("Second Position Letter"). In its Second Position Letter, Westchester reiterated that the damaged fencing was excluded and that the balance of the damages reported on October 5, 2022, had been evaluated and resolved. Westchester also included the above-referenced provision regarding increased cost of construction and the limitation and requirements of the same. Westchester further noted the conclusions of the YAES Report followed by its coverage analysis pertaining to the alleged damage that Richard Group claimed on May 4, 2023. Specifically, Westchester pointed Richard Group to the following Policy language: B. Exclusions 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. … 2. We will not pay for loss or damage caused by or resulting from any of the following: … d.(1) Wear and tear; (2) Rust or other corrosion, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; (3) Smog; (4) Settling, cracking, shrinking or expansion … f. Continuous or repeated seepage or leakage of water, or the presence or condensation of humidity, moisture or vapor, that occurs over a period of 14 days or more. … 3. We will not pay for loss or damage caused by or resulting from any of the following, 3.a. through 3.c. But if an excluded cause of loss that is listed in 3.a. through 3.c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. … c. Faulty, inadequate or defective: (1) Planning, zoning, development, surveying, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property on or off the described premises. Westchester also pointed Richard Group to the "PRE-EXISTING PROPERTY DAMAGE EXCLUSION" found in the Policy, which states: "This policy excludes any loss or damage directly or indirectly caused by, resulting from or contributed to by any pre-existing property damage at the time of loss." Finally, Westchester restated the provisions of the Policy related to calculation of the $100,000 deductible and the limitation to Actual Cash Value, as respects the roof. The YAES Report indicated that the TPO membrane on the roof had been replaced and that the roof leaks occurred after installation. YAES further indicated that some areas of the replaced TPO showed signs of workmanship issues. Westchester noted that according to the YAES Report, the reason for the water intrusion was due to deficiencies in the TPO membrane and flashing along the eaves. Thus, Westchester advised that such damage was not covered. Further, the YAES Report also observed that the staining on the concrete masonry units ("CMUs") showed that the water infiltration had been occurring for an extended period. As a result, Westchester advised that no additional payment would be made. Again, Westchester did not receive any further communication from Richard Group regarding its coverage position set forth in the Second Position Letter until it received the CRN on or about February 10, 2025. • ADDITIONAL DOCUMENTS SENT BY RICHARD GROUP In addition to the Notice of Intent to Initiate Litigation (the "Notice") and the CRN sent on February 10, 2025, Richard Group attached (as Exhibits C and D) an untitled document that appears to be the result of LSC Construction Consultants, LLC's visual inspection of the Property on November 16, 2023, and the accompanying photographs. The document appears to have been created on October 24, 2024. For ease of reference, we will refer to this document as the "LSC Construction Report," the label Richard Group gave the document. According to the LSC Construction Report: LSC Construction Consultants, LLC performed a visual site inspection of the Richard Group, LLC property on November 16, 2023. Rolan Richard was present at the time of the inspection. The purpose of this project was to visually inspect the structure, photograph & document the condition of the structure and/or sampling. The LSC Construction Report is simply an estimate that provides line items of work to be done at the Property, ostensibly without any consideration of what caused the work to be required and/or the terms of the Policy. Of note, the LSC Construction Report includes a line item for roofing that states "Minshall Enterprise Construction Services Roof Replacement dated 12/16/2022." The Minshall estimate in this amount appears to have been attached to the Notice as Exhibit E. Exhibit E again provides no attribution or analysis of the cause of the damage nor the ACV value. In the LSC Construction Report, the unit price, RCV, and ACV for the roofing work are all $430,240.40, indicating that no depreciation was taken into account to reach an Actual Cash Value valuation as required by the Policy as Westchester previously advised. (Line 1.) Also included is $3,467.26 for fencing (Lines 6 & 7), which Westchester also previously advised was not covered. This is, of course, not an exhaustive list of reasons, as the LSC Construction Report also contains many items which were either not due to Hurricane Ian or are not covered under the Policy. We reserve further commentary on the LSC Construction Report but deny that it supports a claim for any further damages arising from the Loss. Curing the CRN: With respect to "cure," the CRN provides that Westchester must "(1): Admit full coverage for the insured's loss; and (2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy." However, as discussed in the various correspondence with Richard Group, there is no additional coverage for the Loss beyond what Westchester has already paid. As the Florida Supreme Court has held, "Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands." Talat Enters., Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1282 (Fla. 2000). Accordingly, Richard Group's proposed method of "cure" is not valid with respect to Westchester, and the CRN is deficient on its face, precluding any action under Section 624.155, Florida Statutes, against Westchester. The Civil Remedy Notice: In relevant part, the CRN alleges that Westchester has violated twelve specific statutory provisions: 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) (Failing to promptly settle claims 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) (Making a material misrepresentation to an insured for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy); 626.9541(1)(i)(3)(a) (Failing to adopt and implement standards for the proper investigation of claims); 626.9541(1)(i)(3)(b) (Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue); 626.9541(1)(i)(3)(c) (Failing to acknowledge and act promptly upon communications with respect to claims); 626.9541(1)(i)(3)(d) (Denying claims without conducting reasonable investigations based upon available information); 626.9541(1)(i)(3)(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); 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); and 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). Richard Group has failed to state how Westchester's alleged actions amount to violations of the cited provisions. Indeed, Westchester undertook a prompt and thorough investigation of the Claim, including the immediate retention of independent consultants to evaluate the alleged damage to the Property both times Richard Group alleged such damages. Instead of detailing the specific "facts and circumstances giving rise to the violation[s]" as required by Section 624.155, Florida Statutes, the CRN contains broad, unfounded assertions and conclusory allegations. Given Westchester's responsive actions, it is not surprising that the CRN lacks the specificity required by Section 624.155, Florida Statutes, of detailing the "facts and circumstances giving rise to the violation[s]" asserted by Richard Group. While the CRN is essentially devoid of factual support for any of Richard Group's allegations, Westchester will respond to the individual statutes it is alleged to have violated, all of which Westchester denies violating. "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." • The Florida Supreme Court "expressly hold[s] that a claim for bad faith pursuant to section 624.155(1)(b)(1) is founded upon the obligation of the insurer to pay when all conditions under the policy would require an insurer exercising good faith and fair dealing towards its insured to pay." Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla. 2000). However, the Florida Supreme Court also "point[ed] out that the denial of payment does not mean an insurer is guilty of bad faith as a matter of law." Id. Further, "[t]he insurer has a right to deny claims that it in good faith believes are not owed on a policy. Even when it is later determined by a court or arbitration that the insurer's denial was mistaken, there is no cause of action if the denial was in good faith." Id. Here, based on the findings of its retained consultants, Westchester properly paid the Actual Cash Value net of deductible for the covered damages submitted as part of the Claim based on the terms of the Policy and denied portions of the Claim based on the Fencing Exclusion, the Wear-and-Tear Exclusion, Continuous Leakage of Water Exclusion, Defective Workmanship Exclusion, and the Pre-Existing Property Damage Exclusion. It did so based not only on its investigations but also on the plain and unambiguous language of the Policy itself. Given the attendant factual circumstances, Westchester appropriately exercised its right to deny those portions of the Claim that it in good faith believes are not covered under the Policy. "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." • This subsection is inapplicable to the factual circumstances here. As discussed at length above, Westchester did not fail to promptly settle the Claim under one portion of the Policy in order to influence a settlement under another portion of the Policy. In fact, Westchester issued payment for the covered portion of the Loss and has denied coverage for the remainder of the Claim. See First Position Letter, Second Position Letter. Moreover, no further obligation to settle has become reasonably clear, given the analysis provided therein. "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." • This subsection is inapplicable to the factual circumstances here. Richard Group has not set forth what "material misrepresentation" was made by Westchester to Richard Group for the purpose of effecting settlement of the Claim on less favorable terms than those provided in the Policy. For good reason: no such misrepresentation was made by Westchester. Instead, Westchester set forth its coverage determination through two letters, to which Richard Group never responded. Westchester's intent was to apprise Richard Group of its determination, not to effect settlement on less favorable terms than contemplated by the Policy. "626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims." • This subsection is inapplicable to the factual circumstances here. Richard Group has not set forth what "standards" Westchester failed to adopt or implement. Westchester did not fail to adopt or implement standards for the proper investigation of the Claim or other claims. Instead, Westchester undertook a full investigation of the Claim, including by retaining independent consultants to assist in its evaluation. "626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue." • This subsection is inapplicable to the factual circumstances here. Richard Group has not set forth what "pertinent facts or insurance policy provisions" were misrepresented by Westchester to Richard Group. Westchester made no misrepresentations relating to the coverages at issue. Instead, Westchester sent two letters explaining its coverage decision and one reservation of rights letter, each letter including relevant policy provisions. "626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims." • This subsection is inapplicable to the factual circumstances here. Westchester promptly acknowledged and investigated in both instances that Richard Group alleged damage to the Property. In fact, when Westchester first received notice of the Claim, Westchester acknowledged the Claim the next day and began investigating within a week of the notice. When Richard Group sent in supplemental damages, Westchester acknowledged the supplemental damages the next day and immediately began investigating the supplemental damages. In addition to its written letters, through its consultants, Westchester remained in contact with Richard Group regarding the status of the Claim. "626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information." • This subsection is inapplicable to the factual circumstances here. As discussed at length above, Westchester conducted more than reasonable investigations based upon the available information. Richard Group has not specified what more it believes Westchester could have done or how Westchester's investigations were unreasonable. Westchester retained Professional Engineer Richard E. Stogran with YAES and Crawford to inspect the Property. Westchester's investigation was more than reasonable based on the information available. "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." • This subsection is inapplicable to the factual circumstances here. Westchester did not fail to affirm or deny full or partial coverage of the Claim. As pointed out in the CRN, Westchester sent "correspondence to the insured dated December 29, 2022 . . . confirming partial coverage, denying the remainder, issuing partial payment for only $241,875.29 . . . ." Further, Richard Group did not provide Westchester with a proof-of-loss statement until February 10, 2025, when Richard Group attached it to the Notice. Westchester did not request the February 10, 2025, proof of loss. Although it had already issued both of its coverage position letters, out of an abundance of caution, Westchester formally rejected the proof-of-loss statement in its Response to the Notice sent on February 24, 2025, within 30 days after the proof of loss was completed, and provided Richard Group with a separate response to the proof-of-loss statement on March 12, 2025. "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." • This subsection is inapplicable to the factual circumstances here. As discussed at length above, Westchester promptly provided Richard Group with a reasonable explanation in writing of the basis in the Policy for its coverage positions. See First Position Letter, Second Position Letter. Richard Group did not respond to either letter. "626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim." • This subsection is inapplicable to the factual circumstances here. As discussed above, Westchester promptly notified Richard Group that Richard Group would need to submit a copy of the final invoice reflecting that a Building Code Upgrade was installed. See First Position Letter. Richard Group has failed to do so. "626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary." • This subsection is inapplicable to the factual circumstances here. As discussed above, Westchester clearly explained to Richard Group that the Policy's Building Code Upgrade coverage was limited and required the work to be actually and timely performed. Further, Westchester explained that Richard Group would need to submit a copy of the final invoice reflecting that a Building Code Upgrade was installed. See First Position Letter. Again, Richard Group failed to do so. "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)." • This subsection is inapplicable to the factual circumstances here. First, the foregoing provision relates to "notice of a residential property insurance claim," meaning it has no application here. Next as discussed at length above, Westchester immediately issued payment in the amount of $241,875.29, within 60 days after Westchester received notice of the Claim, determined the amount of partial benefits, and agreed to coverage under the Actual Cash Value Roof Limitation Form. See First Position Letter. Although Westchester has responded to the foregoing alleged statutory violations, in a separate section, the CRN sets forth eighteen alleged "actions taken by WESTCHESTER in the handling/adjustment of the insured's claim [that] were willful, wanton, and with complete disregard for the rights of its insured and [that] occur with such a frequency as to indicate a general business practice and are in violation of the Fla. Stat. 624.155 and 626.9541": Although Richard Group has failed to provide any evidence of Westchester performing such acts, let alone with frequency or willfulness, wantonness, and complete disregard for the rights of its insured, Westchester further states as set forth below. "1. Claim delay" Richard Group has provided no evidence of any alleged "claim delay" by Westchester. For good reason: there was none. Westchester promptly acknowledged and investigated in both instances that Richard Group alleged damage to the Property. In fact, when Westchester first received notice of the Claim, Westchester acknowledged the Claim the next day and began investigating within a week of the notice. When Richard Group sent in supplemental damages, Westchester acknowledged the supplemental damages the next day and immediately began investigating the supplemental damages. In addition to its written letters, through its consultants, Westchester remained in contact with Richard Group regarding the status of the Claim. "2. Wrongful claim denial" As noted earlier in response to the alleged statutory violations, "[t]he insurer has a right to deny claims that it in good faith believes are not owed on a policy." Vest, 753 So. 2d at 1275. Here, based on the findings of its retained consultants, Westchester properly paid the Actual Cash Value net of deductible for the covered damages submitted as part of the Claim based on the terms of the Policy and denied portions of the Claim based on the Fencing Exclusion, the Wear-and-Tear Exclusion, Continuous Leakage of Water Exclusion, Defective Workmanship Exclusion, and the Pre-Existing Property Damage Exclusion. It did so based not only on its investigations but also on the plain and unambiguous language of the Policy itself. Given the attendant factual circumstances, there was no "wrongful claim denial," and Richard Group has presented no evidence of the same. "3. Unfair trade practice" Richard Group has provided no evidence of any alleged "unfair trade practice" by Westchester. As discussed at length above, Westchester has made no material misrepresentations, has not failed to adopt and implement standards for the proper investigation of claims, has not misrepresented pertinent facts or insurance policy provisions, has not failed to acknowledge and act promptly with respect to the Claim, has not denied the Claim without conducting reasonable investigations based upon available information, has not failed to affirm or deny full or partial coverage of claims, has not failed to promptly provide a reasonable explanation in writing to Richard Group of the basis in the insurance policy for the partial denial of the Claim, has not failed to promptly notify Richard Group of any additional information necessary for the processing of the Claim, and has not failed to clearly explain the nature of the requested information and reasons for the same. "4. Unfair claim settlement practices" Richard Group has provided no evidence of any alleged "unfair claim settlement practices" by Westchester. As discussed at length above, Westchester has made no material misrepresentations, has not failed to adopt and implement standards for the proper investigation of claims, has not misrepresented pertinent facts or insurance policy provisions, has not failed to acknowledge and act promptly with respect to the Claim, has not denied the Claim without conducting reasonable investigations based upon available information, has not failed to affirm or deny full or partial coverage of claims, has not failed to promptly provide a reasonable explanation in writing to Richard Group of the basis in the insurance policy for the partial denial of the Claim, has not failed to promptly notify Richard Group of any additional information necessary for the processing of the Claim, and has not failed to clearly explain the nature of the requested information and reasons for the same. "5. Unreasonable investigation" Richard Group has provided no evidence of any alleged "unreasonable investigation" by Westchester. As discussed at length above, Westchester conducted more than reasonable investigations based upon the available information. Richard Group has not specified what more it believes Westchester could have done or how Westchester's investigations were unreasonable. Westchester retained Professional Engineer Richard E. Stogran with YAES and Crawford to inspect the Property. Westchester's investigation was more than reasonable based on the information available. "6. Failure to act on claim & 12.Failure to acknowledge and act promptly upon communications with respect to claims" With respect to "actions" 6 and 12, Richard Group has provided no evidence of any alleged "failure to act on claim" or "failure to acknowledge and act promptly upon communications with respect to claims" by Westchester. There was none. Westchester promptly acknowledged and investigated in both instances that Richard Group alleged damage to the Property. In fact, when Westchester first received notice of the Claim, Westchester acknowledged the Claim the next day and began investigating within a week of the notice. When Richard Group sent in supplemental damages, Westchester acknowledged the supplemental damages the next day and immediately began investigating the supplemental damages. In addition to its written letters, through its consultants, Westchester remained in contact with Richard Group regarding the status of the Claim. "7. Failure to conduct a reasonable investigation based on available information & 13. Denying claims without conducting reasonable investigations based upon available information" With respect to "actions" 7 and 13, Richard Group has provided no evidence of any alleged "failure to conduct a reasonable investigation based on available information" or "denying claims without conducting reasonable investigations based upon available information" by Westchester. As discussed at length above, Westchester conducted more than reasonable investigations based upon the available information. Richard Group has not specified what more it believes Westchester could have done or how Westchester's investigations were unreasonable. Westchester retained Professional Engineer Richard E. Stogran with YAES and Crawford to inspect the Property. Westchester's investigation was more than reasonable based on the information available. "8. Failure to maintain proper complaint handling procedures" Richard Group has not set forth what "proper complaint handling procedures" Westchester failed to maintain. Westchester did not fail to maintain proper complaint handling procedures for the proper investigation of the Claim or other claims. Instead, Westchester undertook a full investigation of the Claim, including by retaining independent consultants to assist in its evaluation. "9. Misrepresenting the insurance policy provisions to the insured & 10. Misrepresenting Florida statutory provisions to the insured & 11. Misrepresenting facts to the insured" With respect to "actions" 9, 10, and 11, Richard Group has not set forth what insurance policy provisions, Florida statutory provisions, or facts were misrepresented by Westchester to Richard Group. Westchester made no misrepresentations relating to the coverages at issue. Instead, Westchester sent two letters explaining its coverage decision and one reservation of rights letter, each letter including relevant policy provisions and how they were being applied to the circumstances presented. "14. 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." Westchester did not fail to affirm or deny full or partial coverage of the Claim. As pointed out in the CRN, Westchester sent "correspondence to the insured dated December 29, 2022 . . . confirming partial coverage, denying the remainder, issuing partial payment for only $241,875.29 . . . ." Further, Richard Group did not provide Westchester with a proof-of-loss statement until February 10, 2025, when Richard Group attached it to the Notice. Westchester did not request the February 10, 2025, proof of loss. Although it had already issued both of its coverage position letters, out of an abundance of caution, Westchester formally rejected the proof-of-loss statement in its Response to the Notice sent on February 24, 2025, within 30 days after the proof of loss was completed and provided Richard Group with a separate response to the proof-of-loss statement on March 12, 2025. "15. 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." Westchester did not fail to "promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy" for denial of the Claim. As discussed at length above, Westchester promptly provided Richard Group with a reasonable explanation in writing of the basis in the Policy for its coverage positions. See First Position Letter, Second Position Letter. Richard Group did not respond to either letter. "16. Failing to promptly notify the insured of any additional information necessary for the processing of a claim & 17. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary." With respect to "actions" 16 and 17, Westchester did not fail to "promptly notify the insured of any additional information necessary for the processing of a claim" or fail to "clearly explain the nature of the requested information and the reasons why such information is necessary." As discussed above, for example, Westchester clearly explained to Richard Group that the Policy's Building Code Upgrade coverage was limited and required the work to be actually and timely performed. Further, Westchester explained that Richard Group would need to submit a copy of the final invoice reflecting that a Building Code Upgrade was installed. See First Position Letter. Richard Group failed to provide the requested information. "18. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed." First, the foregoing provision relates to "notice of a residential property insurance claim," meaning it has no application here. Next as discussed at length above, Westchester immediately issued payment in the amount of $241,875.29, within 60 days after Westchester received notice of the Claim, determined the amount of partial benefits, and agreed to coverage under the Actual Cash Value Roof Limitation Form. See First Position Letter. As shown above, Richard Group essentially broke down the alleged twelve statutory violations into eighteen separate "actions" allegedly taken by Westchester. And as noted above, none of the "actions" have support in the evidence. Indeed, the CRN fails to provide specific support for any of the alleged "actions" taken by Westchester. As set forth in this response, Westchester fully complied with its obligations under applicable law and the terms of the Policy. As Westchester has explained above, it denies any wrongdoing pursuant to any of the statutes cited and the 18 enumerated items above. Accordingly, based on the lack of information provided in the CRN and the inaccuracy of the allegations made in the CRN, Richard Group has failed to perfect its right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, and cannot pursue the civil remedy authorized therein. Westchester believes this letter is a sufficient response to the CRN but will supplement the response if necessary. Should Richard Group and/or the Department require further evidence, elaboration, or clarification in the context of the CRN and this response, please do not hesitate to contact the undersigned on behalf of Westchester. Please note that Westchester continues to reserve all rights at law, in equity and/or under the Policy, waiving none. Thank you, Taylor L. Davis Clyde & Co US LLP
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