Civil Remedy Notice of Insurer Violations
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Filing Number:     807370
Filing Accepted:  2/18/2025
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Complainant
Last/Business Name *  
HICKS   First Name   JOHN
Street Address * 707 POINSETTIA AVENUE
City, State Zip * ELLENTON, FL 34222
Email Address * JHICKS83@TAMPABAY.RR.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HICKS   First Name   JOHN
Policy # * 7515528703 Claim #* 01000126815
Attorney
Attorney is Applicable
Last Name* MARTINEZ First Name * KELLI Initial A.
Street Address* 3411 W. FLETCHER AVE, STE. B
City, State Zip* TAMPA , FL 33618
Email Address * PRESUIT@SULIMARTINEZLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FRONTLINE INSURANCE UNLIMITED COMPANY
NAIC Company Code 10074
 
Name of individual responsible for violation (if any):* DARLA SIRLS, AHIESHA KIDD AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, FRONTLINE INSURANCE, WHO WAS INVOLVED IN THE CLAIM.DARLA SIRLS, AHIESHA KIDD AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, FRONTLINE INSURANCE, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Unsatisfactory Settlement Offer
Claim Delay
Claim Denial
Other : Violation of Code of Ethics
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured’s loss
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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.
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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 7515528703, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS FAILURE TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS. THE VIOLATIONS ALLEGED ARE ALSO STATUTORILY BASED AND DO NOT RELY ON ANY SPECIFIC POLICY LANGUAGE. THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 7515528703, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS FAILURE TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS. THE VIOLATIONS ALLEGED ARE ALSO STATUTORILY BASED AND DO NOT RELY ON ANY SPECIFIC POLICY LANGUAGE.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Frontline Insurance has committed the following in handling the insured’s claim: 1. Failing to act in due diligence and good faith to resolve claims 2. Placing the financial interest of the Carrier before that of the Insured 3. Looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims. 4. Not adjusting the claims promptly and fairly 5. Not attempting in good faith to settle claims 6. Conducting Inadequate investigations 7. Failing to employ policies and procedures to conduct adequate investigations 8. Failing to provide an estimate that complies with the Florida Building Codes. 9. Shifting the burden of investigating the loss onto the Insured. 10. Misrepresenting the terms of the insurance policy. 11. Failing to provide a copy of the insurance policy within 30 days. 12. Failing to provide a loss run statement within 15 days. John Hicks is a homeowner with an all-risks insurance policy issued by Frontline Insurance (hereinafter “Carrier”),. On or about October 9, 2024, while the policy was in full force and effect, the Insured’s property located at 707 Poinsettia Ave Ellenton, FL 34222-2424 sustained significant damage as a result of a hurricane. The insured promptly reported the claim and fully cooperated with the carrier’s investigation. The Carrier assigned claim number 01000126815 to the loss. After reporting the claim, Carrier retained an unqualified and biased field adjuster to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insured’s interest, the adjuster made a conscious effort to ignore evidence of covered losses to the property. Then in a letter dated October 23, 2024, the carrier notified the Insured that it had completed its investigation into the loss and concluded the damages were under the deductible of $6,477.00. Given the vastly underestimated cost of repairs, the Insured’s disagreement with the coverage decision, and the scope and nature of the damage resulting from the loss, the Insured through its retained representatives disputed the coverage determination and submitted an estimate prepared by Proctor Claims Adjusting, LLC for $37,916.53 which was a fair and reasonable assessment of the loss. Worst still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition within reasonable time. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and bias adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition evidences Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and bias adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidences Carrier’s failure to conduct a reasonable investigation based upon available information. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. 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 based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer’s representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The conduct outlined above is done within the Insurer’s routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured’s interests or safety. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied full coverage for the claim. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured’s ability to have his claim adjusted promptly to begin restoring his property. The Insurer’s actions amount to but are not limited to the following: 1. Claim Delay: The Carrier has delayed processing the claim, causing frustration and inconvenience to the Insured. 2. Lack of Good Faith Conduct: The Carrier has not treated the Insured with good faith conduct expected when handling claims. 3. Attempt to Reduce Recovery: The Carrier has actively sought ways to minimize the amount owed to the Insured under the policy. 4. Attempt to Deny Recovery: The Carrier has looked for reasons to deny coverage altogether, rather than fulfill its obligations under the policy. 5. Failure to Property Evaluate Loss: Claims have not been assessed accurately or promptly, resulting in delays and incomplete indemnity for the Insured. 6. Inadequate Training and Supervision of Adjusters: The Carrier has not ensured its adjusters are adequately trained to handle claims promptly and fairly. 7. Placing Company Interests over Insured Interests: The Carrier has prioritized its financial interests over the health and safety of the Insured. 8. Failure to Provide Complaint Estimates: Estimates provided by the Carrier do not comply with Florida Building Codes. 9. Shifting Investigation Burden to Insured: The Carrier has unfairly placed the burden of investigating the claim onto the Insured. 10. Conducting Inadequate Investigations: The Carrier’s Investigation into the claim have been insufficient or cursory. Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: 1. Admit full coverage for the Insured’s loss and tender all additional amounts owed under the Policy for the covered loss to the insured property Please email any responses to this civil remedy notice to presuit@sulimartinezlaw.com A copy of this form submitted to the FDFS has been sent via email to the following parties, providing them notice of the filing of the civil remedy notice: • Frontline Insurance via DFS Filing • Claims Department, Frontline Insurance, via portal submission. • John Hicks via email jhicks83@tampabay.rr.com
Comments
User Id Date Added Comment
Presuit@sulilaw.com 04-18-2025 This CRN is hereby withdrawn.
steebagy@thetmlaw.com 04-16-2025 April 16, 2025 Electronic Filing Florida Department of Financial Services Consumer Assistance/Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, FL 32399-0322 Complainant: John Hicks Policy No.: 7515528703 Claim No.: 01000126815 Date of Loss: Reported as 10/9/24 CRN Filing No.: 807370 Dear Sir or Madam: Please be advised that this law firm represents Frontline Insurance Unlimited Company (“FIUC”) and First Protective Insurance Company d.b.a. Frontline Insurance (“Frontline”) with respect to the Civil Remedy Notice of Insurer Violations (hereinafter “CRN”) filed by Kelli A. Martinez, Esquire in relation to Claim Number 01000126815 (hereinafter “Claim”) under the policy of insurance issued by Frontline to its insured, John Hicks (hereinafter “Insured”) bearing Policy Number 7515528703 (hereinafter “Policy”). As a threshold matter, the Insured has agreed to withdraw this CRN pursuant to an agreement between the parties and, therefore, all allegations therein are withdrawn and mooted. Since that withdrawal has not yet occurred, to the extent a response remains necessary, FIUC responds that it is the only insurer named in the CRN; however, FIUC did not issue any policy to the Insured. As such, the CRN is wholly defective and fatally flawed as there is no standing to FIUC and no required statutory notice has been given to the insurer who issued the Policy, that being Frontline. Without waiver and in abundance of caution, Frontline and FIUC further respond that the subject CRN is overbroad, objectionable, legally insufficient, fails to comply with Florida law and otherwise satisfy Florida law and further deprives any true notice with adequate opportunity to cure. All allegations in the CRN, including but not limited to alleged violations of Sections 624.155 and 626.9541, Florida Statutes, are denied. In the CRN, the Insured fails to provide specific and sufficient information to support such allegations. Rather, the Insured only provides inaccurate, boilerplate allegations and omissions with no basis in fact or circumstance. The CRN recites five statutory provisions allegedly violated without any specificity. The CRN also impermissibly makes legal argument rather than setting forth specific facts as it relates to the unsupported allegations contained therein, all of which are expressly denied. Additionally, the CRN fails to recite particular Policy language allegedly relevant to any claimed violation. A Civil Remedy Notice must contain, among other things, the specific policy language that is relevant to the alleged violations, persons most responsible and the facts and circumstances giving rise to the alleged violation. See § 624.155 (3)(b), Fla. Stat. (providing CRN to the Department of Insurance and an authorized insurer must state with specificity the following information: . . . ( 2) the facts and circumstances giving rise to the violation . . . (4) reference to specific policy language that is relevant to the violation, if any . . . .); Heritage Corp. of South Florida v. Nat ’l Union Fire Ins. Co. of Pittsburgh, 580 F.Supp. 2d 1294, 1299-1300 (U.S. S.D. Fla. 2008). The subject CRN is therefore insufficient as it fails to list the “specific policy language that is relevant to the violation.” Id. If the terms of the insurance Policy were violated as alleged, the subject CRN must include the “terms of the insurance coverage”. Id. The Insured’s CRN fails to include this. Thus, the CRN fails to meet the requirements of the applicable Florida law. See § 624.155 (3)(b), Fla. Stat. Furthermore, simply listing what amounts to a Table of Contents of the Policy is insufficient to comply with either the spirit or the letter of the applicable law. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2020) (holding insured failed to satisfy the specific requirements that a Civil Remedy Notice identify the specific statute and specific policy provision relevant to the carrier’s alleged violations). Similarly, the CRN fails to state a cure with specificity also in violation of Florida law. The Claim was handled pursuant to appropriate standards governing the investigation of claims. Frontline has acted in good faith, fairly and honestly towards its Insured and with due regard for his interests as well as complied with all other requirements pursuant to Florida law. Thus, as set forth herein, the CRN fails to comply with Florida law, including the notice and pleading requirements of Section 624.155, Florida Statutes. The CRN is also overbroad, objectionable, improper, and insufficient as noted herein. The alleged violations and allegations of bad faith in the CRN are unfounded, misleading, insufficient, and denied by FIUC and Frontline. Frontline has handled the Claim in compliance with the Policy and Florida law. Frontline’s response is not waiver of statutorily required notice or acquiesce to the failure to provide same. FIUC and Frontline also assert that this response is not necessarily exhaustive and does not preclude either from asserting any other valid facts or defenses to the CRN. We trust that this correspondence addresses any concerns or questions which you may have regarding the CRN file. Please feel free to contact us if you have any remaining questions, comments or require any additional information. Very truly yours, The Teebagy & Medeiros Law Group, PLLC /s/ Crystalin C. Medeiros Crystalin C. Medeiros For the Firm CC: Kelli A. Martinez, Esquire (Via email: Presuit@sulimartinezlaw.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.

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DFS-10-363
Rev. 10/14/2008