Civil Remedy Notice of Insurer Violations
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Filing Number:     806266
Filing Accepted:  2/11/2025
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Complainant
Last/Business Name *  
6TH ST LAND TRUST #519   First Name  
Street Address * 519 6TH ST
City, State Zip * LIVE OAK, FL 32064
Email Address * PROACTIVEINVESTMENTSINC@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   6TH ST LAND TRUST #519   First Name  
Policy # * F35824L24 Claim #* 4FH00018
Attorney
Attorney is Applicable
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNDERWRITERS AT LLOYD'S, LONDON
NAIC Company Code
 
Name of individual responsible for violation (if any):* MELLS MEHR & ASSOCIATES
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

"Appraisal. If you and we fail to agree on the amount of loss, either may demand an appraisal of the loss. In this event, each party will choose a competent appraiser within 20 days after receiving a written request from the other. "
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On December 18, 2024, the Public Adjuster representing the insured submitted a signed Sworn Proof of Loss, an estimate, and a written appraisal demand to the insurer. Pursuant to the terms of the insurance policy, the insurer was required to appoint an appraiser within 20 days of receiving the demand. However, the insurer failed to do so. A follow-up email was sent on January 16, 2025, within the same email thread, highlighting that nearly 30 days had passed without a response. A second follow-up was sent on January 21, 2025, noting that 34 days had passed since the original demand. The insurer responded only after this third communication,claiming they had never received the initial appraisal demand, despite the fact that they replied within the same email thread where the demand was clearly included. The insurer then requested the Public Adjuster to copy another email address on future communications, citing internal email issues. Despite complying with this request and resending all necessary documents, the insurer subsequently denied the appraisal request and rejected the Proof of Loss claiming they were still investigating the loss and had only just received the documents on January 21, 2025. This assertion is false, as the insurer had previously replied to the email thread originating on December 18, 2024. Furthermore, on November 11, 2024, when the insurer acknowledged the Letter of Representation, they replied using only their personal email without copying the company’s general claims email. They did not mention any internal email issues at that time or request any other email addresses to be included moving foward. It is not the responsibility of the Public Adjuster or the insured to anticipate or manage the insurer's internal communication problems. The insurer's failure to timely acknowledge and act upon communications, refusal to proceed with the appraisal process as outlined in the policy, and reliance on internal issues as a defense is a violation of Florida Statutes §624.155 and §626.9541. As well as failure to respond to a sworn proof of loss within 30 days Section 627.736 Cure Demand: To remedy these violations, the insurer must take the following actions immediately: Appoint an appraiser without further delay as required under the terms of the insurance policy or Pay the full amount of damages in the amount of $80,256.80 to the insured.
Comments
User Id Date Added Comment
jeremy@interstateadjusting.com 05-22-2025 The matter has been resolved between both parties and the insured withdraws the CRN.
dania@sselegal.com 04-02-2025 Re: Response to Civil Remedy Notice of Insurer Violations D.F.S. File No.: 806266 Insurer: Certain Underwriters of Lloyd’s London Insured: 6th Land Trust #519 Underwriters Claim No. 4FH00018 Underwriters Policy No. F35824L23 Date of Loss: September 26, 2024 Please be advised that our firm represents and is acting on behalf of Certain Underwriters at Lloyds, London Subscribing to Policy No. F35824L23 (hereinafter “Underwriters”). Underwriters issued an insurance policy to the insured with effective dates of 10/03/23-10/03/24. This will acknowledge receipt of the Civil Remedy Notice of Insurer Violations (“CRN”) No. 806266. The claim arises from damage allegedly caused by Hurricane Helene. Underwriters first request that the CRN be rejected as it fails to comply with the requirements set forth in Section 624.155, Florida Statutes, and Florida case law. The CRN generally alleges that Underwriters: failed to attempt in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly towards its insured in violation of §§624.155(1)(b)(1) and624.155(1)(b)(3). The CRN further alleges that Underwriters (a) failed to adopt and implement standards for the proper investigation of claims; (b) misrepresented pertinent facts; (c) failed to acknowledge and act promptly with respect to the claim; and (d) failed 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 and has violated various provisions of Florida Statute §626.9541(1)(i). Underwriters vehemently denies any and all statutory violations as alleged by the insured. Underwriters contend that the CRN as filed is deficient as a matter of law as it fails to comply with Section 624.155. 316 Inc. v. Maryland Casualty Insurance Company, 526 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Insurance Corp., 2010 WL 7367059, (S.D. Fla. 2010); Heritage Corporation of South Florida v. National Union Fire Insurance Company of Pittsburgh, PA, 580 F. Supp. 2d 1294 (S.D. Fla. 2008). Pursuant to Section 624.155(3)(b), the notice "shall state with specificity" the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. The facts and circumstances giving rise to the violation; 3. The name of any individual involved in the violation; 4. Reference to specific policy language that is relevant to the violation; if any; and 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by the section. First and foremost, the CRN fails to allege any facts to notify Underwriters of any of the specific statutory violations at issue. Therefore, the CRN is insufficient as a matter of law. As such, the CRN lacks the requisite specificity required by Section 624.155(3)(b)(3). Finally, the CRN also fails to satisfy Section 624.155(3)(b)(4) in that it fails to reference any policy language. The CRN does not cite any provision of the policy. The failure to cite any policy language allowing Underwriters to investigate the allegations renders the CRN insufficient pursuant to Florida law. As such, the CRN does not satisfy the specificity required by Section 624.155(3)(b)(4). Also, the CRN fails to specify the policy language and provisions that are relevant or applicable to the alleged facts contained in the CRN. Because the CRN fails to identify any specific statutes that apply to the allegations, Underwriters is unable to properly respond, and the CRN should be rejected and returned. Additionally, the CRN fails to set forth any specific policy language alleged to have been violated in accordance with Florida Statutes Section 624.155(3)(b)(4). The failure to identify any specific policy provision that is allegedly relevant to the alleged violations prevents Underwriters from addressing any issues regarding the policy and, as a result, the CRN should be rejected. The CRN sets forth various "cures" for the alleged defects. There are also multiple "cures" in the CRN that are improper pursuant to Florida case law, specifically the case of Talat Enterprises, Inc. v. Etna Casualty & Surety Company, 753 So. 2d 1278 (Fla. 2000). The Talat case provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amount due to the insured. Talat also commented that "it naturally follows that for there to be a 'cure,' what had to be 'cured' is the non-payment of the contractual amount due the insured. In the context of a first-party insurance claim, the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to the payment are fulfilled...." As a result, the "cures" in the CRN not relating to payment are improper remedies and contrary to Florida law. The CRN also requires the Complainant to "describe the facts and circumstances giving rise to the insurer's violation as you understand them at this time," the purpose of which is "to enable the insurer to investigate and resolve the claim." Instead of providing facts and circumstances, the CRN contains conclusory, unsupported statements as to the claim. The tenor and inferences of the allegations are wholly without merit and Underwriters denies all of the insured’s allegations. The facts are as follows: On October 18, 2024, Insurers issued a coverage determination letter advising the insured that the field adjuster’s investigation revealed wind damage to the roof covering and the vinyl siding of the rear elevation. After application of the policy’s applicable deductible, the net claim totals $1,767.85. On November 11, 2024, Insurers received a Letter of Representation from Interstate Public Adjusters, LLC. On November 27, 2024, Insurers issued an email to the public adjuster requesting the claim supporting documentation. On December 16, 2024, Insurers issued a reiteration payment letter to the insured advising that no additional supporting documentation have been provided to evaluate the previous payment for the loss. On December 18, 2024, Insurers received a document package from Interstate Public Adjusters, LLC, including an estimate totaling $80,256.80 RCV/$76,743.49 ACV, Executed Sworn Statement in Proof of Loss, and an Appraisal Demand Letter. (This document package was not received by the desk adjuster). On January 21, 2025, Insurers received a follow up email from the insured’s public adjuster requesting Insurers to select their named appraiser. Additionally, Insurers received a document package including an estimate totaling $80,256.80 RCV/$76,743.49 ACV, Executed Sworn Statement in Proof of Loss, and an Appraisal Demand Letter. On February 3, 2025, Insurers issued a letter to the insured acknowledging receipt of the Appraisal Demand Letter. Additionally, Insurers denied the request for Appraisal and advised that the demand is premature as there is a disputed scope of damages to the interior of the property which were either not documented by the insured during the triage or reported to the field adjuster at the time of the inspection. On February 3, 2025, Insurers issued a letter to the insured acknowledging receipt of the Proof of Loss and advised that the Proof of Loss is neither accepted nor rejected as the amount claimed is not an accurate reflection of the indemnifiable loss covered by the policy. On February 3, 2025, Insurers issued a Reservation of Rights letter advising the insured of the policy’s exclusions, conditions, endorsements, and/or limitations which may apply to the loss. Additionally, Insurers requested a reinspection of the property with an engineer. However, the insured failed to comply with the request for the engineer inspection. The insured has prematurely requested appraisal before the post loss obligations have been complied with. The insured must comply with all of the policy's post-loss obligations before the appraisal clause is triggered. See United Prop. & Cas. Ins. v. Concepcion, 83 So. 3d 908, 910 (Fla. 3d DCA 2012) (citing Citizens Prop. Ins. v. Gutierrez, 59 So. 3d 177 (Fla. 3d DCA 2011); Citizens Prop. Ins. v. Mango Hill Condo. Ass'n 12 Inc., 54 So. 3d 578 (Fla. 3d DCA 2011); Citizens Prop. Ins. Corp. v. Maytin, 51 So. 3d 591 (Fla. 3d DCA 2010)). Thus, the Civil Remedy Notice of Insurer Violation is without merit. Underwriters acted timely and appropriately to adjust the claim. In the event the insured can demonstrate any loss for which it has not been fairly and fully compensated, Underwriters stands ready to fully compensate the insured for such loss, within the terms of the Policy. With respect to the allegations of the CRN, Underwriters submits that it has at all times acted in the utmost good faith in the handling of the claim and, further, has made payment based upon the estimate and documentation presented subject to the Policy’s terms, conditions, exclusions, and endorsements. Please contact us at your convenience in the event we can be of additional assistance to your examination of the Civil Remedy Notice.
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