Civil Remedy Notice of Insurer Violations
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Filing Number:     807545
Filing Accepted:  2/19/2025
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Complainant
Last/Business Name *  
CLARK   First Name   DOROTHY
Street Address * 914 SAGO PALM WAY
City, State Zip * APOLLO BEACH, FL 33572
Email Address * JODI@LAWHUGGINS.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CLARK   First Name   DOROTHY
Policy # * PFL131676-10 Claim #* CFL24605589
Attorney
Attorney is Applicable
Last Name* PETERS First Name * JODI Initial
Street Address* 6421 N FLORIDA AVE D-598
City, State Zip* TAMPA , FLORDIA 33604
Email Address * JODI@LAWHUGGINS.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):* CHANDRA WALLACE, PATRICK HOBBS, GARRETT FAIR
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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.
624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
624.155(1)(b)(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.
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.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* 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 Insurer has not provided a copy of the Policy, despite the Insureds’ request. The violations described herein derive from Florida law concerning insurers’ obligations to their insured. See, e.g., Fla. Stat. Chapters 626, 627. Specific policy language that may be relevant to the violations include, but are not limited to, the following: Building Coverage provisions, All Additional Coverages provisions, All Coverages provided by Endorsement or Rider, The Declarations, Page Loss Payment, Settlement provision, and the insurance policy's definition section.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Insurer’s adjuster(s) assigned to this claim were/are: Chandra Wallace, Patrick Hobbs, Garrett Fair ,. Hereinafter referred to as the “Adjuster” or “Adjusters”. - On February 19, 2025, the undersigned sought to verify that Adjuster Flair held a valid Florida adjusting license and appointment, performing a search on https://licenseesearch.fldfs.com for the following terms: ‘Fair’, and ‘Fair & ‘Garrett’. No person matching Adjuster Flair arose in the search results. Although persons named ‘Garrett Fair’ arose in the search results, it was impossible to verify whether Adjuster Fair was in fact licensed and appointed. Moreover, none of the entries show any links to the Insurer. Accordingly, it is likely that Adjuster Fair lacked a Florida adjusting license and/or was not appointed during the administration of this claim. Here, the Insurer has violated Fla. Stat. § 626.112(1)(a) (“No person may be, act as, or advertise or hold himself or herself out to be an insurance agent, insurance adjuster, or customer representative unless he or she is currently licensed by the department and appointed by an appropriate appointing entity or person. [...] Any person who knowingly transacts insurance or otherwise engages in insurance activities in this state without a license in violation of this section commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.”). Here, the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices. The insurer also violated the provisions of Florida Statute § 624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim 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 his interests. Moreover, the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. - The Insured suffered a loss due to hurricanes that occurred on or about September 26, 2024 and October 9, 2024. The Insured’s covered property was damaged by the loss. On October 22, 2024, the Insurer admitted that the Property sustained damage from the Loss that was covered by the Insured’s insurance policy (policy number stated above; hereinafter the “Policy”)—for which the Insurer assessed a replacement cost value of $2,483.51 (“Insurer Estimate”), a mere 2% of the eventual cost incurred to repair the property. The Insurer Estimate was prepared and authored by Adjuster Fair. The Insurer Estimate was patently deficient in that it omitted entire categories of damage that would have been visible to and recognizable by any person viewing the damaged Property, let alone a qualified insurance adjuster. It is important to note that some of these damages are not latent; they are patent and easily observable through cursory investigation. Upon review of the Insurer’s estimate, it became clear to the Insured that the Insurer patently undervalued the replacement cost value of the Property by omitting obvious damages and that the Insured would not fully restore the Property to the condition it was in prior to the loss by failing to pay the Insured all the benefits to which the Insured is entitled under the Policy for the loss. Here, the insurer violated the provisions of Florida Statute § 624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim 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 his interests; the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims; the Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(2) by making a misrepresentation to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy; the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information; the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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; and the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices. - The Insured hired Lightman & Fields Public Insurance Adjusters (“Lightman”) to assist in the proper administration of the insurance claim. Having conducted thorough investigations and analysis, Lightman prepared an estimate of costs to repair the damaged property in the amount of RCV $98,445.00. Lightman sent the Insurer a letter of representation on December 17, 2024, providing Lightman’s claim file and requesting information—including a copy of the policy, claim payment history, and other claim documents. - Despite the Insureds’ December 17, 2024 request for the same, the Insurer has not provided a copy of the Policy, a claim payment history, and other requested claim documents. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon communications with respect to claims. - On November 4, 2024 Adjuster Fair sent a letter underpaying the claim based upon a report from the insurer’s field adjuster that failed to account for the proper repair of the observed damages. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices as a result. - The roof damage is consistent with hurricane force wind, showing impact from flying debris. Due to the extent of damages and the requirement of a proper repair under Florida law, a full roof replacement would be warranted under the Policy. Desirous to avoid this cost, Adjuster Fair wrongfully underpaid the insurance claim by making the above misrepresentations. The Insurer violated the provisions of Florida Statute § 624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim 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 his interests. The Insurer violated the provisions of Florida Statute § 624.155(1)(b)(3) by 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. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices. - On November 4, 2024 Adjuster Fair sent the Insured correspondence indicating that $2,157.66 (approximately 2%) of the Claim would be paid. However, he provided scant rationale as to how he arrived at this figure/percentage despite the detailed corroborative information provided by the Insured. In this way, the insurer violated the provisions of Florida Statute § 624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim 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 his interests. The insurer violated the provisions of Florida Statute § 624.155(1)(b)(2) by making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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 the offer of a compromise settlement. - Moreover, Adjuster Fair denied approximately 98% of the Claim. However, in this correspondence or at no point did Adjuster Fair meaningfully explain why 98% of the Claim was being denied. Here, the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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. And, the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices. - The Insurer’s conduct in this case is one instance a pattern of business practice designed to avoid or delay coverage determinations for claims, supplemental claims, and/or additional claims by failing to render a determination when requested, failing to make payments of undisputed amounts of claims, and 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. - To cure the conduct giving rise to the violations described herein, insurer must: (i) pay the total replacement cost value of the Insured’s Claim in the amount of $98,445.00, less prior payments and the deductible; (ii) make payment of any pre-judgment interest owed under Florida law; (iii) make payment for the additional expense incurred by the Insured in hiring an attorney; and (iv) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this Claim.
Comments
User Id Date Added Comment
bfrankel@gmail.com 03-26-2025 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 Insured, Dorothy Clark (“Insured”). 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 Insured’s 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 10/12/2024, PTI was advised of damages resulting from Hurricane Milton, as occurring on 10/9/2024. Specifically, it was reported that the dock was blown away, the roof tiles had blown off, the roof was leaking over the bedrooms, and the screens were blown out of the florida room and off the pool enclosure. Subsequently, on 10/22/2024, 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, the FA observed damage to the soffit and gutter on the front and rear elevation, as well as damage to the ridge cap tile. It was also noted that there were 3ft flood cuts throughout the home. In light of the observed damages associated with the reported event, PTI’s Field Adjuster prepared an estimate accounting for roof repairs, and the soffit and fascia. As a result, PTI issued a Coverage Determination Letter on 12/2/2024 confirming coverage for the items in the estimate, but excluding damage to the interior, pool enclosure and dock. As explained in the letter, the dock and damaged screens were subject to exclusion under the hurricane loss provision. As for the interior damages, those were determined to be pre-existing from the prior Hurricane Helene claim. Regarding the covered damages, the letter explained that those damages were measured at Actual Cash Value and did not exceed the applicable deductible; therefore, the claim was not compensable and no loss payments were owed under the policy at the time. To the extent additional damages not previously reported or considered were discovered, the Insured was instructed to provide and/or communicate that information to PTI for review and consideration. 2) A few weeks after the reported loss, PTI received a Letter of Representation from Lightman & Fields Public Adjusters, Inc. (“Insured’s Public Adjuster”), as well as an estimate in the amount of $98,445.00. In response, the desk adjuster acknowledged receipt and a certified copy of the policy was provided on 1/2/2025. Following these communications, PTI received a Letter of Representation from Huggins Law Firm (“Insured’s Attorney”) on 2/19/2025 and provided them a copy of the coverage letter and the Field Adjuster’s estimate on 2/26/2025. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law, and has not engaged in any actions listed under “reasons for notice,” which include claim denial, claim delay, unsatisfactory settlement offer, and unfair trade practice. In response thereto, PTI advises that coverage was acknowledged in this matter; however, no payments were issued and/or owing as the damages assessed by PTI’s Field Adjuster did not exceed the applicable deductible. A copy of this coverage letter was provided to the Insured’s Attorney along with the estimate. As it relates to claim delay, PTI specifically denies this allegation as the timeline of events details how PTI promptly and timely investigated the subject claim and responded to correspondence and documents submitted by and on behalf of the Insured. As it relates to unfair trade practice, the CRN does not provide any information in support of this and therefore PTI denies said allegations. 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. 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 Insured’s 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. PTI accepted coverage and provided the Insured with PTI’s estimate and scope of repairs supporting the ACV amount not exceeding the applicable deductible. The letter also cited to the relevant portions of the applicable policy in relation to the excluded areas/items, as well as the loss settlement provision. 2) ALLEGED VIOLATION §624.155(1)(b)(2) – Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. RESPONSE PTI denies this alleged statutory violation and also advises it is inapplicable as no claim payments have been made as of today’s date as the assessed damages did not exceed the applicable deductible to warrant the issuance of any claim payments in relation to the claim. 3) ALLEGED VIOLATION §624.155(1)(b)(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. RESPONSE PTI denies this alleged statutory violation. As shown in the claims summary above, PTI accepted coverage and provided the Insured with PTI’s estimate and scope of repairs supporting no payments are due and owing as the damages did not exceed the applicable deductible. Since that time there has been no documentation submitted showing additional damages not previously reported or considered that would warrant further consideration and/or evaluation of the claim. Moreover, the Insured does not indicate what portion(s) of the policy coverage became reasonably clear nor what portion(s) of the policy were used to influence settlement. Accordingly, it is impossible to further respond to this allegation. 4) 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. 5) ALLEGED VIOLATION §626.9541 (1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. RESPONSE The Insured does not indicate what facts and/or policy provisions were misrepresented. Hence, PTI denies this alleged statutory violation. 6) ALLEGED VIOLATION §626.9541 (1)(i)(3)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. RESPONSE PTI denies that this alleged statutory violation. As indicated in the numbered paragraphs above, all communications were not only promptly responded to but also promptly acted upon. All correspondence have been reviewed and acknowledged, a certified copy of the policy was provided to the Insured’s Public Adjuster on 1/2/2025 and the coverage letter was sent to the Insured’s Attorney on 2/26/2025. 7) 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 Claimants have not provided any facts to sustain such an allegation. As mentioned above, the Insured has not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented. Furthermore, PTI promptly investigated the claim, and acknowledged coverage after the post-loss property inspection. This allegation is baseless and the alleged violation is emphatically denied. 8) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As mentioned above, PTI accepted coverage and provided the Insured with PTI’s estimate and scope of repairs supporting the ACV amount not exceeding the applicable deductible. The letter also cited to the relevant portions of the applicable policy in relation to the excluded areas/items, as well as the loss settlement provision. 9) ALLEGED VIOLATION §626.9541 (1)(i)(3)(i) – Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). RESPONSE The subject claim and instant CRN involves a homeowner’s insurance policy and dispute and does not involve any allegations and/or facts related to personal injury. For that reason, PTI advises this alleged violation is irrelevant and hereby denied. CONCLUSION /SUMMATION In sum, PTI timely accepted coverage under Florida law and maintains that all alleged violations of Florida Statutes in this CRN are baseless, and the CRN offers no facts in support of the statutory violations alleged. In fact, the CRN broadly, vaguely and without a scintilla of evidence, alleges boilerplate, unsupported false allegations of statutory violations and tracks, in generalities and conclusions only, the language of numerous sections of Florida’s Civil Remedy Statutes without connecting the purported statutory violations to the facts of the claim and the history of the claims investigation. Moreover, the CRN also fails to include specific policy language relevant to the violation(s). In response to these very general allegations, and to comply with its statutory obligations, PTI responds by denying each and every allegation of misconduct asserted in the CRN, whether expressed and or implied, and by categorically denying each and every alleged statutory violation.   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. As always, PTI is willing to consider any additional information the Insureds can provide in support of their claim. We trust the foregoing fully explains the facts and circumstances of the claim and addresses any concerns raised. If we can provide other information or clarification of information in the claim, please do not hesitate to contact the undersigned. Thank you for your attention to this matter. Very truly yours, /S/ Cosima Ortiz Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Jodi Peters, Esq. 6421 N Florida Ave D-598 Tampa, Fl 33604 E-mail: jodi@lawhuggins.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