Civil Remedy Notice of Insurer Violations
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Filing Number:     806825
Filing Accepted:  2/14/2025
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Complainant
Last/Business Name *  
BHAGHANI AND THE LIFE ESTATE OF MOHAMMAD AND SALMA BHAGHANI   First Name   MOHAMMAD AND SALMA
Street Address * 8936 SOUTHERN BREEZE DRIVE
City, State Zip * ORLANDO, FL 32836
Email Address * CFAUNTLEROY@FSATLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BHAGHANI AND THE LIFE ESTATE OF MOHAMMAD AND SALMA BHAGHANI   First Name   MOHAMMAD AND SALMA
Policy # * 80-CC-R187-3 Claim #* 59-69S7-74S
Attorney
Attorney is Applicable
Last Name* FAUNTLEROY First Name * CHRISTOPHER Initial B
Street Address* 100 S ASHLEY DRIVE, SUITE 600
City, State Zip* TAMPA , FLORIDA 33602
Email Address * CFAUNTLEROY@FSATLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* DONALD CAMERON AND STATE FARM AND ITS ADJUSTERS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference specific policy language that is relevant to violation: COVERAGE A COVERAGE A – DWELLING 1. Dwelling. We cover the dwelling and materials and supplies located on or adjacent to the residence premises for use in the construction, alteration, or repair of the dwelling or other structures on the residence premises. LOSS SETTLEMENT COVERAGE A – DWELLING 1. A1 – Replacement Cost Loss Settlement – Similar Construction. a. We will pay the cost to repair or replace with similar construction and for the same use on the premises shown in the Declarations, the damaged part of the property covered under SECTION I – PROPERTY COVERAGES, COVERAGE A – DWELLING, except for wood fences, subject to the following: (1) we will pay only the actual cash value at the time of the loss prior to repair or replacement of the damaged part of the property, up to the applicable limit of liability shown in the Declarations, not to exceed body whether intentional, wrongful, negligent, or without fault; b. defect, weakness, inadequacy, fault, or unsoundness in: (1) planning, zoning, development, surveying, or siting; (2) design, specifications, workmanship, repair, construction, renovation, remodeling, grading, or compaction; (3) materials used in repair, construction, renovation, remodeling, grading, or compaction; or (4) maintenance; of any property (including land, structures, or improvements of any kind) whether on or off the residence premises; or c. weather conditions. However, we will pay for any resulting loss from items 3.a., 3.b., and 3.c. unless the resulting loss is itself a Loss Not Insured as described in this Section. LOSS PAYMENT 8. Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable upon the earlier of the following: a. 20 days after we receive your proof of loss and reach agreement with you; or b. 60 days after we receive your proof of loss and: (1) there is an entry of a final judgment; or (2) there is a filing of an appraisal award with us. If we do not pay or deny a loss within 90 days after we receive notice of an initial, reopened, or supplemental property insurance claim from you and no factors beyond our control would reasonably prevent us from making payment, interest will be paid in accordance with Section 627.70131(5) of the Florida Insurance Code. ***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:*** §624.155(1)(B)(1) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 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 towards its insured and with due regard for her interests; 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or 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. §624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (a) Willful, wanton, and malicious; (b) In reckless disregard for the rights of any insured; or (c) In reckless disregard for the rights of a beneficiaries under a life insurance contract; (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. §627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. (4) For purposes of this section, the term “insurer” means any residential property insurer. §626.9541(i) Unfair Claim Settlement Practices
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. State Farm Insurance Company (State Farm) has breached this duty in the adjustment of Mohammad Y Bhaghani’s and Salma Bhaghani’s (the Bhaghanis’) claim. State Farm has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice. Furthermore, State Farm has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices. The Bhaghanis’ claim results from wind and hail damage to their home that occurred on June 20, 2024. To mitigate the damages to their home, the Bhaghanis contacted their insurance company, State Farm, to report the damages. As part of the investigation of the Bhaghanis’ claim, State Farm assigned a claim number 59-69S7-74S and claims specialist Donald Cameron. State Farm inspected the damages to the Bhaghanis’ property on August 30, 2024. Subsequently, State Farm denied the Bhaghanis’ claim and did not provide any monetary compensation and coverage to return the Bhaghanis’ property back to pre-loss condition. In view of the foregoing, it is clear and unequivocal that State Farm has failed to provide proper and sufficient compensation to repair the damages caused to the Bhaghanis’ property. Due to State Farm’s handling of the Bhaghanis’ claim, the Bhaghanis chose to retain a licensed roofer and a public adjuster to further assess the damages to their home. As such, upon inspection and view of the damages, it was clear that the roof and the interior of the property required extensive repair. After the inspection, the public adjuster prepared an estimate for repairs in the amount of $18,929.99, in determining the extent of damages to the interior, while the licensed roofer prepared an estimate for $162,000.00 which is the amount to repair the damages caused to the roof and State Farm continues to hold their stance for their claim determination concerning the Bhaghanis’ loss. The Bhaghanis have complied with all conditions under the policy. Nonetheless, State Farm failed to properly compensate the Bhaghanis for their loss. The facts of this claim show that for whatever reason, State Farm not only substantially misinterpreted the scope of damages to the Bhaghanis’ property, but also failed to conduct a thorough investigation as to the scope of damages to the roof and interior. Upon view of State Farm’s claims handling procedures, it is clear State Farm conducted a limited and quick outcome orientated investigation in the hopes that the Bhaghanis would make the required repairs with their own money. The Bhaghanis now must incur costs for assistance to obtain what should have been paid had they been treated fairly and honestly by State Farm. Florida Statute §626.9744(2) provides that “When a loss requires replacement of items and the replaced items do not match in quality color or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas”. In the instance of State Farm, their adjusters and the estimate provided, it is clear that State Farm did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of the Bhaghanis’ home as well as the surrounding areas that would need to be replaced. Florida Statute §624.02, defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or a determinable benefit, upon determinable contingencies – inherent is the fact that payment must be made timely and promptly. The fact that payment must be made timely and promptly so that the insureds may mitigate their damages, and to put the insureds back into the position they enjoyed prior to the loss as quickly as possible. State Farm has breached this duty by improperly investigating the Bhaghanis’ claim and failing to properly pay the Bhaghanis for their loss. State Farm has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards the Bhaghanis. In view of the facts surrounding the Bhaghanis’ claim, it is evident that State Farm has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, State Farm has failed and/or refused to investigate the insureds’ claim thoroughly, accurately, and completely for damages. Furthermore, State Farm has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service, and indemnity, has failed to conduct a full and fair investigation of the claim. Florida Statutes Violated by State Farm are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined. § 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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)(3)a Failing to adopt and implement standards for the proper investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims. Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. State Farm can cure this default by the following: A. Create, adopt, and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims. B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future. C. Tender payment to the Bhaghanis in the amount of $180,929.99, which is the amount to return the Bhaghanis’ home back to pre-loss condition. D. Tender prejudgment interest from the date the claim was reported through today. E. Agree to pay the Bhaghanis’ reasonable attorney’s fees pursuant to Florida Statute §627.428 and all taxable costs.
Comments
User Id Date Added Comment
mfuller@kpsds.com 04-15-2025 VIA E-Mail Only Christopher B. Fauntleroy, Esq. Fauntleroy & Satmary, P.A. 100 S. Ashley Drive, Suite 600 Tampa, FL 33602 cfauntleroy@fsatlaw.com Re: Insureds: Mohammad Bhaghani & Salma Bhaghani and the Life Estate of Mohammad Bhaghani & Salma Bhaghani Claim No.: 59-69S7-74S DFS Filing No.: 806825 Dear Mr. Fauntleroy: As you know, we represent State Farm Florida Insurance Company (“State Farm”) regarding the above-referenced matter. We are in receipt of the Civil Remedy Notice (“CRN”) you filed on behalf of your clients, Mohammad Bhaghani and Salma Bhaghani and the Life Estate of Mohammad Bhaghani and Salma Bhaghan (the “Insureds”), against State Farm on February 14, 2025, with a DFS Filing Number 806825. Please allow this correspondence to serve as State Farm’s response to the CRN. The stated reasons for the CRN are listed as: claim denial; unsatisfactory settlement offer; and unfair trade practice. The CRN claims State Farm violated Florida Statutes: 624.155(1)(b)(1); 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b); 626.9541(1)(i)(3)(c); 626.9541(1)(i)(3)(d); and 626.9541(1)(i)(3)(f). As a preliminary matter, State Farm denies it violated the statutes cited in the CRN. As of the date of this correspondence, we note that you provided no new information regarding these allegations since the time of State Farm’s initial response to the CRN and request for information dated February 18, 2025. Specifically, we had requested that you provide us with any factual information to support the allegations in the CRN. We indicated that we would be happy to review any details you may have supporting these allegations. As an initial matter, the CRN is deficient and fails to comply with the requirements of Florida law. The purpose of a Civil Remedy Notice is to provide an insurer with a chance to settle the claim and avoid unnecessary litigation. See Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000); see also, The Heritage Corporation of South Florida v. National Union Fire Insurance Company of Pittsburgh, P.A., 580 F.Supp. 2d 1294 (S.D. Fla. 2008). In furtherance of this purpose, Florida Statute § 624.155(3)(b) requires that a Civil Remedy Notice “state with specificity” the statutory provisions allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language relevant to the violation. Rather than include the specific policy language relevant to the alleged statutory violations cited in the CRN as required by § 624.155(3)(b), Florida Statutes, the CRN broadly references Coverage A - Dwelling and the Loss Payment and Loss Settlement provisions of the policy. The CRN fails to provide any explanation as to how State Farm failed to comply with the terms of the policy and/or any specific language in the policy pertaining to the alleged incident. The failure to identify the specific policy language at issue plainly renders the Civil Remedy Notice deficient under § 624.155(3)(b), Florida Statutes. See Junior Julien v. United Property and Casualty Insurance Company, No. 4D19-2763 (Fla. 4th DCA September 23, 2020); Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294, at *2 (M.D. Fla. Apr. 28, 2017). In addition, the “facts and circumstances” section of the CRN is not in compliance with Florida law. Contrary to the requirements of Florida Statutes, the CRN makes false, boilerplate accusations, and does not contain any specific facts supporting the violations alleged. For example, the CRN fails to provide any factual support for various allegations regarding State Farm’s alleged claim denial, unsatisfactory settlement offer and unfair trade practice, or its alleged violations of those statutory provisions noted above and in the CRN. As more fully discussed below, the allegations contained within the CRN are false, and the CRN contains no facts to support them. Although the CRN alleges that State Farm “failed to properly compensate the Bhaghanis for their loss,” the following summary demonstrates that State Farm has acted responsibly and in good faith during the investigation and handling of this claim. The failure to provide any factual support for the alleged violations of Florida statutes and administrative law renders the CRN deficient and in violation of Florida Statute § 624.155(3)(b). Not waiving the aforesaid CRN deficiencies, it appears on June 24, 2024, a claim was reported by the Insureds for wind damage sustained to the insured property located at 8936 Southern Breeze Drive, Orlando, Florida 32836 (the “Property”). A date of loss of June 20, 2024 was provided by the Insureds at the initial time of reporting. The Insureds were unresponsive to State Farm’s initial contact attempts to discuss their reported claim which resulted in a delay of access to the Property. Ultimately, the Insureds permitted State Farm access to inspect the Property on August 30, 2024 and August 31, 2024. During State Farm’s inspections, no accidental direct physical loss resulting from wind or hail was observed to the Property. Additionally, non-covered damage resulting from, but not limited to, wear, tear, deterioration and mechanical breakdown was observed to the Property. Water damage to the interior ceiling of the dining room was reported to State Farm; however, based on the investigation, it was determined the reported damage was long-term in nature and not sustained on the reported date of loss. These findings were explained to the Insureds in State Farm’s coverage determination letter dated September 11, 2024. In addition, on or about September 4, 2024, State Farm informed the Insureds of their right to mediation through the Department of Financial Services in the event they disputed State Farm’s adjustment of the claim. On or about February 11, 2025, correspondence from your office requesting a mediation was received by State Farm. In furtherance of State Farm’s investigation, on April 4, 2025, an engineer with Probe Forensic Engineering, LLC was permitted access to perform an inspection of the Property. Based on the investigation, the engineer determined there was not any wind or hail damage sustained to the Property in connection with the reported June 20, 2024 date of loss. The engineer’s findings support State Farm’s denial of the Insureds’ claim. The CRN states “claim denial” as a reason for notice and wrongfully alleges that State Farm “failed to properly compensate the Bhaghanis for their loss,” “substantially misinterpreted the scope of damage to the Bhaghanis’ property,” and “failed to conduct a thorough investigation as to the scope of damages to the roof and interior.” However, the facts outlined above in this response clearly demonstrate that State Farm properly adjusted the Insureds’ claim based on the information available to it at the time of reporting and pursuant to the Insureds’ policy of insurance. State Farm’s letter dated September 11, 2024, expressly provided an explanation of the coverage decision along with the applicable policy provisions to the Insureds. Therefore, the CRN’s allegation of claim denial is unfounded and denied by State Farm. Second, the CRN alleges “unsatisfactory settlement offer” as a reason for notice and alleges that that State Farm is “not attempting in good faith to settle claims.” As previously explained, the facts set forth in this response clearly demonstrate that State Farm properly adjusted the Insureds’ claim based on the information available to it at the time of reporting and pursuant to the Insureds’ policy of insurance. State Farm’s letter dated September 11, 2024, expressly provided an explanation of the coverage decision along with the applicable policy provisions to the Insureds. There is no evidence of bad faith by State Farm to adjust and settle the Insureds’ claim. Thus, this allegation is denied by State Farm. Lastly, the CRN claims “unfair trade practice” as a reason for notice and alleges that State Farm “did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of the Bhaghanis’ home as well as the surrounding areas that would need to be replaced.” In addition, the CRN claims “State Farm has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim service and indemnity; has failed to conduct a full and fair investigation of the claim.” The CRN fails to provide any facts or evidence in support of these boilerplate allegations. Rather, the facts outlined above in this response exhibit that State Farm properly rendered its coverage decision based upon completion of its investigation of the Insureds’ claim, to include its inspection of the Property, and applied the provisions of the Insureds’ policy of insurance to its findings. Therefore, State Farm denies the allegation of unfair trade practice. In closing, the claim facts demonstrate that State Farm has fully and properly adjusted the claim in accordance with the insurance policy and Florida law to the best of its ability. Additionally, State Farm has handled this claim in the appropriate manner and in good faith, doing everything it could reasonably do to timely and properly investigate the Insureds’ claim and pay benefits where owed. Further, State Farm has acted at all times fairly and honestly towards the Insureds and in the best interest of the Insureds, consistent with the terms and conditions of the contract for insurance and Florida law. For the reasons set forth above, State Farm denies the allegations contained in the CRN. However, we would welcome the opportunity to review any additional information you may have that you believe supports your clients’ position. Should you have any documents or other information that State Farm has not had the opportunity to review, please provide those at your earliest convenience. Very truly yours, /s/ M. Megan Fuller M. Megan Fuller MMF cc: Client
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