Civil Remedy Notice of Insurer Violations
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Filing Number:     806763
Filing Accepted:  2/13/2025
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Complainant
Last/Business Name *  
LE   First Name   ANTHONY
Street Address * 103 CYPRESS POINT EAST
City, State Zip * PENSACOLA, FL 32514
Email Address * ALEDMD13@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LE   First Name   ANTHONY
Policy # * PFL444135-00 Claim #* CFL23598865
Attorney
Attorney is Applicable
Last Name* MAHONEY First Name * JOHN Initial
Street Address* 4290 WOODBINE RD.
City, State Zip* PACE , FLORIDA 32571
Email Address * JMAHONEY@ARLAWLLC.NET
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):* YOUSY VALDES, BILLY RICE, AND OTHER ASSIGNED ADJUSTERS.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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.

POLICY PROVISIONS VIOLATED: The insurance company is in breach of the Coverage sections of the subject policy PFL444135-00. ADMINISTRATIVE CODE SECTIONS VIOLATED: 69B-220.201(3)(b) – An adjuster shall treat all claimants equally. 69B-220.201(3)(b)2. – An adjuster shall adjust all claims strictly in accordance with the insurance contract. 69B-220.201(3)(c) – An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insureds. 69B-220.201(3)(d) – An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 69B-220.201(3)(o) – An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This notice is given in order to perfect the right of the insured, Anthony Le (“insured”) to pursue the civil remedy authorized by Fla. Stat. §624.155 against his insurer, People’s Trust Insurance Company (“the insurance company”). The insurance company has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the claim of loss of its insured and has failed to pay for covered damages in breach of the insurance policy. This claim arises from covered damages sustained after a water loss in the master bathroom that occurred on June 26, 2023. The water loss damaged the bathroom as well as the kitchen area on the floor underneath. The insurance company was timely notified of the loss and assigned claim number CFL23598865. The insured sought the assistance of a public adjuster and also obtained a damage/repair estimate for damages across all coverages. The insurance company opened up coverage under the policy. The insurance company’s payments were wholly insufficient to address the loss or indemnify the claim. The insured timely disagreed and supplemented. The insured provided a PA estimate, signed contractor contract, contents inventory, and mold mitigation documentation. The insurance company ignored this information that they requested and failed to properly indemnify the insured for all his covered losses. To date, despite acknowledging coverage for the loss and notwithstanding the insured’s pleas otherwise, the insurance company has failed and refused to pay all insurance benefits due and owing under the policy and has failed and refused to restore the insured property to pre-loss condition. The insurance company’s valuation of the loss did not begin to approach a necessary amount to repair the property to pre-loss condition. The insured requested the insurance company to pay the full amount of money needed to address his covered losses. After attempts to obtain a fair claim settlement failed, the insured was left with no choice but to hire an attorney to pursue insurance company for its breach of the insurance policy in failing to pay the full policy value of the loss. Implicit within every insurance policy is a duty of good faith and fair dealing. However, the insurance company has failed to comply with those obligations in connection with this claim. Instead, the insurance company has looked for ways to avoid paying the claim in full and these actions have been to the detriment of the insured. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of the insurance company have approached this investigation in a manner prejudicial to the insured. The insurance company used either untrained or improperly trained adjusters in connection with this claim. The insurance company should have been adjusting the loss with the insured but instead, it was looking for ways not to pay the claim in full. If the insurance company handles all the claims in the way it handled the insured’s claim, then it is improperly handling all claims. The insurance company’s conduct has been reckless and unfair to the insured. The concept of insurance is that insurance is the insurers’ granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate his damages and be placed back into the position she was in prior to the loss as quickly as possible. The insurance company has breached this duty. The insurance company should have acted fairly and honestly towards the insured. Instead, the insurance company refused and/or failed to settle the insurance claim when under all circumstances it could have. This is wrongful conduct. Further, the insured contend that the insurance company’s adjusters and/or representatives financially benefitted from such wrongful conduct. Therefore, to cure the defects outlined in this Civil Remedy Notice, the insurance company must: create and implement adequate guidelines for proper investigation and evaluation as to claims handling and for the training and supervision of employees. This would have helped the insurance company avoid the statutory violations set forth above and may help the insurance company prevent such violations from occurring in the future. In addition, the insurance company must create and implement adequate guidelines for the proper investigation and evaluation of these types of claims. The insurance company should also offer appropriate training and supervision of employees with regard to these types of claims to ensure the insurance company’s claims handling procedures are adequate to prevent the unfair and wrongful treatment that the Insured experienced. To remedy the above issues the insurance company must act fairly and honestly towards the insured and with due regard for his best interests in attempting to settle the insured’s claim. The insurance company must immediately tender all insurance benefits due and owing to the insured under the policy pursuant to the relevant policy provisions provided therein. The necessary remedy payments would also include all interest due and owing under applicable Florida Statutes and all attorney’s fees and costs incurred by the insured because of the bad faith conduct of the insurance company. Stated another way, the insurance company must pay the insured the fair value of his insurance claim. This remedy would reasonably place the insured back to the pre-loss condition that is contemplated in his policy and would resolve the outstanding disputes.
Comments
User Id Date Added Comment
jmahoney@morganlawgroup.net 03-13-2025 This issue has been resolved between the parties and the CRN is hereby withdrawn by Anthony Le.
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