Civil Remedy Notice of Insurer Violations
Login

Filing Number:     806677
Filing Accepted:  2/13/2025
         Print Filing
Complainant
Last/Business Name *  
BIGELOW   First Name   MELISSA AND PORTER
Street Address * 6347 SAINT ANDREWS CIR S
City, State Zip * FORT MYERS, FL 33919
Email Address * ISSA0472@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BIGELOW   First Name   MELISSA AND PORTER
Policy # * PFL310319-07 Claim #* CFL22594929
Attorney
Attorney is Applicable
Last Name* FERNANDEZ First Name * NATALIE Initial
Street Address* 333 SE 2ND AVE, SUITE 2000
City, State Zip* MIAMI , FL 33131
Email Address * NFERNANDEZ@DKLAWFL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* CLAIMS DEPARTMENT AND/OR LASHAWN TODD
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information; 624.155(1)(b)(1), Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests; 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims. The Carrier’s actions set forth above also violated the following policy provisions: Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

February 13th, 2025, Sent Via U.S. Mail & Email People’s Trust Insurance Company (Claims department and/or LaShawn Todd) 18 Peoples Trust Way Deerfield Beach FL 33441 RE: Insured(s) : Melissa L. Bigelow and Porter K. Bigelow (“insured(s)”) Policy # : PFL310319-07 Claim # : CFL22594929 Property Address : 6347 Saint Andrews Cir S Fort Myers, FL 33919- Insured(s) Email : Issa0472@hotmail.com Dear People’s Trust Insurance Company, (“carrier”): Please find enclosed the civil remedy notice filed for the above referenced claim. As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. The carrier was put on notice of the insureds’ claim that occurred on 09/28/2022. After being put on such notice, the carrier initially sent a representative to inspect the property. It is believed the representative initially sent to the property was unqualified or lacked the necessary training to determine the cause of the damages observed during the inspection. It is also believed that the representative initially sent to the property was unqualified or lacked the necessary training to determine the amount of damages sustained as a result of the loss. It is upon information and belief that the carrier’s initial representative observed widespread hurricane damages to the property. The initial representative was unable to rule out hurricane as the cause of the damages observed during the inspection of the property. After the cursory inspection of the property, the carrier sent a coverage letter to the insured. The coverage letter provided by the carrier advised the insured there was no coverage for the loss. The policy exclusions/reasons for not extending coverage cited to by the carrier are not supported by the information known to the carrier or the representative that inspected the property at the time the coverage decision was made for the loss. The carrier and its representative lacked necessary information needed to support the incorrect conclusions regarding the cause of the damages to the property. The carrier and its representative relied on a boilerplate exclusion that were not supported by the facts of the loss tin order to deny the claim. It is clear by the language of the carrier’s denial letter that it did not determine what caused the damages observed at the property. The carrier just included various exclusions under the policy. The carrier inspected the property with a representative that was not qualified to determine what caused the damages to the property. After this cursory inspection, the carrier issued its denial letter. The carrier also did not value or evaluate the amount of damages observed to the property. This shows the carrier did not adjust the loss with the insured. The carrier engages in this practice of incorrectly denying claims with such regularity DENNIS KESSLER PLLC 333 Southeast 2nd Ave, Suite 2000 and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of the insured. The carrier routinely relies on unsupported conclusions to deny claims based on exclusions under the policy that do not apply to the facts of the loss at the time the carrier issued its coverage decision. The carrier denied the claim without conducting a reasonable investigation and failed to properly adjust the loss. The carrier’s actions have severely delayed the resolution of this claim. Rather than inspecting the property and evaluating the damage in a prudent manner or making any good-faith effort to investigate the claim, the carrier incorrectly denied the claim. This investigation by the carrier is in direct violation of the statutory requirement for carriers to promptly and properly investigate all claims. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information; 624.155(1)(b)(1), Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests; 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims. The Carrier’s actions set forth above also violated the following policy provisions: Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. The carrier has mishandled the claim in a classic textbook bad-faith claims handling practice by stonewalling, stalling, and failing to adjust and properly cover the claim by retaining outcome- oriented agents that did not evaluate the loss, coverage, or information objectively. Had the carrier taken the time to properly investigate this claim, reviewed the readily available guidelines, or sent qualified unbiased people out to the property to investigate, the insured would not be in this situation. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed and acknowledged in writing; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the insured’s interests; refusing to cover the claim and pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the insured’s loss in a timely manner. The carrier engages in this practice of attempting to delay and deny claims in order to maximize the carrier’s profit margins with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of the insured. It is clear that the carrier is not treating the insured with good faith claims conduct. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $ $29,351.01; 2.) Pay the Insureds’ attorneys’ fees DENNIS KESSLER PLLC 333 Southeast 2nd Ave, Suite 2000 and costs as they have been forced to retain counsel; 3.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been printed out and mailed. Please do not hesitate to contact the undersigned if you have any questions or concerns. Sincerely, Enclosed: Civil Remedy Filing Natalie Fernandez, Esq. Attorneys at Law
Comments
User Id Date Added Comment
bfrankel@gmail.com 04-07-2025 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of its Insureds, Melissa and Porter Bigelow (“Insureds”). In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. To be more specific, the CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information the department may require: (1) The statutory provision, including the specific language of the statute, 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. If the person bringing the civil action is a third-party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. (5) A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted property and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insureds’ CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes.   1) On 10/31/2022, the Insured called to report damages due to Hurricane Ian, as occurring on 9/28/2022. Specifically, the Insured reported that the breather vents for the roof were damaged, but was unsure whether any shingles or tiles were missing. Additionally, it was reported that the rain gutters and rain gutter screens were damaged and blown off. At the time of reporting there was no tarp on the roof and no repairs had been made. Following the reporting, on 11/6/2022 PTI’s Field Adjuster inspected the home in order to determine the cause of loss and scope of damages. At the time of the inspection, PTI’s Field Adjuster observed minor wind damage to two shingles on the rear right slope and a ridge vent on the roof. As for the exterior elevations, there was wind damage to the shutters, patio screening, window screens and overhead door at the front elevation, and wind damage to the gutters and downs on the right and rear elevations. There was also a tree that had been knocked down over the driveway. 2) As a result of the investigation, on 12/29/2022, PTI issued its coverage determination letter. Within the letter, PTI advised the Insureds that their claim is covered, and the insured would be indemnified by means of repair, in accordance with the policy. Accordingly, PTI timely elected its option to effectuate covered repairs through a preferred contractor, Rapid Response Team (“RRT”), pursuant to the terms and conditions of the Policy and its endorsements. The letter goes on to explain all relevant policy language and endorsements, and also advised the Insureds to submit a Sworn Proof of Loss (“SPOL”) and supporting estimate of their scope dispute in the event that they are not in agreement with PTI’s assessment. 3) Subsequently, and as an alternative to the election to repair, PTI issued a Claim Settlement Offer correspondence on 2/7/2023. Within the letter, PTI enclosed a settlement offer check and explained that if the offer was not accepted the election to repair would remain in effect and PTI would proceed accordingly as set forth in the coverage determination letter. There was no further activity on the file until PTI received an estimate and photos seven (7) months later, which was acknowledged by PTI along with communications that the estimate for replacement was being rejected and did not show additional damages outside of what PTI had accounted for by way of repairs, and that the photos of the roof failed to depict storm damage and instead displayed conditions consistent with wear, tear, and deterioration. Following these communications, PTI received a Letter of Representation from Dennis Kessler PLLC (“Insureds’ Attorney”). 4) Upon receipt of the aforementioned documentation, PTI issued a Request for Information Letter on 10/19/2024 in which PTI requested all estimates, invoices, documents and photographs concerning the subject claim and reported damages, as well as a Sworn Proof of Loss. Thereafter, on 11/8/2024, PTI formally withdrew its election to repair and issued an undisputed payment. The Insureds then submitted a SPOL which was followed by a Notice of Intent to Initiate Litigation (Notice No.: 230372) filed on 2/13/2025 and responded to by PTI on 2/24/2025. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. While the CRN references “claim delay and claim denial” as reasons for the notice, it fails to mention specific policy language or factual support related to said allegations. While it does mention provisions relating to coverage absent an exclusion and requiring payment within 90 days, it does not appear to be taking into account the fact that PTI did in fact acknowledge coverage within the required timeframe and invoked its election to repair in lieu of monetary payment and in accordance with the policy at issue. Additionally, contrary to the CRN allegations, the above-referenced timeline of events shows that PTI acted timely in its adjustment of the claim and communications with the Insureds and/or Insureds representatives, and thoroughly investigated the claim by way of an initial inspection in order to confirm coverage under the subject policy. Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies of all the statutory violations alleged in the Insureds’ CRN. 1) ALLEGED VIOLATION §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: RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As stated above, PTI’s coverage determination letter acknowledged coverage and invoked its election to repair in lieu of a monetary payment; however, subsequent to that PTI issued a Claim Settlement Offer letter as an alternative to resolve the claim and to allow the Insureds to effectuate repairs with a contractor of their choosing. Upon receipt of documentation evidencing a dispute amongst the parties, PTI formally withdrew its election to repair and issued undisputed payment. Moreover, upon receipt of the SPOL and supporting documentation, PTI engaged in attempted settlement negotiations with undersigned counsel. Therefore, any allegations regarding failure to act in good faith to settle the claim are inaccurate. 2) ALLEGED VIOLATION §626.9541 (1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006) As the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. 3) ALLEGED VIOLATION §626.9541(1)(i)(3)(d) – Denying claims without conducting reasonable investigations based upon available information. RESPONSE PTI denies this alleged statutory violation and advises that coverage was afforded for the wind damaged roof tiles and exterior damages covered under the subject policy. As indicated in the numbered paragraphs above and summary above, PTI promptly inspected the home and timely reviewed and responded to all documentation submitted by the Insureds. CONCLUSION /SUMMATION As outlined above, PTI maintains that it has not been in violation of any law and that PTI timely accepted coverage and elected to make repairs to the Insureds’ property, in compliance with the Policy. While the CRN alleges that in order to “cure” the alleged violation, PTI must pay the complete covered loss in the amount of $29,351.01, as well as attorneys’ fees. However, PTI maintains that it has at all times acted in good faith with regard to the claim, and has not breached any duty owed. PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. Should the Department require additional information, please do not hesitate to contact us. Very truly yours, Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Natalie Fernandez, Esq. 333 SE 2nd Ave., Suite 2000 Miami, Fl 33131 E-mail: nfernandez@dklawfl.com
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