Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 807711

Filing Accepted: 2/20/2025

Print Filing

Complainant

Last/Business Name *

LOCKSPEISER

First Name

JACK AND CARYN

Street Address *

1120 NE 175TH ST

City, State Zip *

NORTH MIAMI BEACH, FL 33162

Email Address *

N/A

Complainant Type: *

Insured

Last/Business Name*		LOCKSPEISER		First Name		JACK AND CARYN
Policy # *		NF033FL0307638		Claim #*		EV2023033637

Attorney

Attorney is Applicable

Last Name*	ELIMELECH First Name * REBECCA Initial R
Street Address*		1500 N.E. 162ND ST.
City, State Zip*		MIAMI , FLORIDA 33162
Email Address *		RELIMELECH@ILGPA.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		NATIONAL FIRE & MARINE INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 20079

Name of individual responsible for violation (if any):* N/A
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.
	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)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I - PROPERTY COVERAGES A. Coverage A - Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". C. Coverage C - Personal Property 1. Covered Property We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by: a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or b. A guest or a "residence employee", while the property is in any residence occupied by an "insured". SECTION I - PERILS INSURED AGAINST A. Coverage A - Dwelling and Coverage B - Other Structures 1. We insure against risk of direct physical loss to property described in Coverages A and B. B. Coverage C - Personal Property We insure for direct physical loss to the property described in Coverage C caused by any of the following perils unless the loss is excluded in Section I - Exclusions.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Jack and Caryn Lockspeiser (hereinafter the “Insureds”), paid for a policy of insurance with National Fire & Marine Insurance Company (hereinafter, “Insurer”) bearing policy number NF033FL0307638 (the “Policy”). The Policy provides coverage for damage to the Insureds’ property located at 1120 NE 175th St, North Miami Beach, FL 33162 (the “Property”), including the significant damage that occurred as a result of a raccoon making a hole in the roof on or about April 14, 2023 (the “loss”). Specifically, the Insureds’ Property sustained substantial damage to the roof, interior and exterior of the home. There is damage to the shingles. In the interior, the affected areas are the ceiling above the dining room, den, kitchen, living room, foyer, bedroom and guest room. In the bedroom, there is damage to the ceiling, side drywall, floors and furniture. In the living room and in the guest room, there is water damage to the carpet floors and the furniture. Personal contents were damaged, including the bed with storage drawers, twin size mattress, desk with shelves above, printer stand, computer desk, swivel desk chair, seat couch, recliner, large wood storage unit, bookcases, double dresser with mirror, desk lamp and rolling suitcases. The Insureds promptly reported their claim to the Insurer. On May 31, 2023, the Insurer sent a letter to the Insureds advising of their preliminary estimate, in which the damages to the Property totaled $25,222.52 for the dwelling and $4,512.27 for ordinance and law. On June 6, 2023, the Insurer issued a letter stating that the Insureds are entitled to payment in the amount of $25,222.52. The Insureds contacted the Consumer Law Office, which has merged with the Insurance Litigation Group, P.A. (hereafter, ILGPA), who conducted a thorough inspection of the property and compiled an estimate of damages. ILGPA, on behalf of the Insureds, forwarded said estimate which fully detailed the Insureds’ damages and total $92,982.93. However, the Insurer refuses to resolve the Insureds’ claim and pay for all damages to the Property. The Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims. First, Florida Statute § 624.155(1)(B)(1) requires good faith in the settlement of claims. The Insurer is in violation of this Statute for failing to provide a reasonable repair estimate. The Insurer’s estimate only acknowledges interior damage to the bedroom ceiling, den and dining room. The Insureds have been unable to repair the significant interior damages to the property because of the Insurer’s initial underpayment. What is more, the Insurer violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle the claim, when the obligation to settle the claim became reasonably clear. Again, the Insurer failed to make a good faith offer to settle this claim and failed to account for the full scope of the damages. They failed to respond to the estimate provided by ILGPA, on the Insureds’ behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insureds’ Property, and not attempt to resolve this claim with lowball offers. Additionally, the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. The Insurer’s estimate overlooks many areas of the home that were damaged. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insureds and its counsel. As mentioned above, the Insurer failed to account for the full scope of the damages and has additionally failed to respond to the estimate provided by ILGPA, on behalf of the Insureds, in a timely manner, delaying the resolution of this claim. Had the Insurer done so, it would have immediately settled this claim on a fair and reasonable basis and provided full coverage to its Insureds. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations and avoid this from occurring in the future; (2) immediately tender all insurance proceeds due and owing its Insureds under the Policy in the amount of $92,982.93 (less the deductible and any prior payments), plus all statutory interest; (3) act fairly and honestly towards its Insureds and with due regard for their interests in attempting to settle their Insureds’ claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insureds to suffer either further loss and/or damage; and, (5) stipulate to the Insureds’ entitlement to attorney’s fees and court costs pursuant to Florida Statutes §§ 627.428 and 626.9373. Acknowledgment This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes section 624.155, should National Fire & Marine Insurance Company fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.

Comments

User Id		Date Added		Comment
ssmith@marlowadler.com		04-15-2025		While National Fire & Marine Insurance Company ("NF&M") categorically rejects any claims that it and/or its representative engaged in any prohibited conduct or violated any statutes referenced in the Notice and instead asserts that it and/or its representatives acted in good faith, without delay and with due regard for the Insureds’ interests at all times during the investigation, handling and adjustment of the Claimants’ claim, this claim was amicably resolved on April 7, 2025, including any and all alleged claims of bad faith and/or improper claims handling by NF&M. If the Department has any questions or needs any further information, NF&M can be contacted through its counsel, Stephen P. Smith, Esq., Marlow Adler Abrams & Rotunno, 4000 Ponce de Leon Blvd, Coral Gables FL 33146, (786) 999-1785.

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