Civil Remedy Notice of Insurer Violations
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Filing Number:     807958
Filing Accepted:  2/21/2025
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Complainant
Last/Business Name *  
WHITEHALL CONDOMINIUMS OF THE LANDS OF THE PRESIDENT ASSOCIATION, INC.   First Name  
Street Address * 3700 WHITEHALL DRIVE
City, State Zip * WEST PALM BEACH, FL 33401
Email Address * WHITEHALLCONDOSLOP@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WHITEHALL CONDOMINIUMS OF THE LANDS OF THE PRESIDENT ASSOCIATION, INC.   First Name  
Policy # * CA4P000246211 Claim #* 9-3285
Attorney
Attorney is Applicable
Last Name* STRUBLE First Name * MATTHEW Initial
Street Address* 325 FIFTH AVENUE, SUITE 103
City, State Zip* INDIALANTIC, FL 32903 , FLORIDA 32903
Email Address * SERVICE@STRUBLECOHEN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   EVEREST NATIONAL INSURANCE COMPANY
NAIC Company Code 10120
 
Name of individual responsible for violation (if any):* CHRISTOPHER DURAN, CHARLES TAYLOR, NATALIE THOMAS, THORNTON TOMASETTI, YOUNG & ASSOCIATES, AND ANY AND ALL SPECIFIC REPRESENTATIVES OF INSURER RESPONSIBLE FOR THE VIOLATIONS HEREIN
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

There are no policy provision specifically at issue or in dispute, the policy provides coverage resulting from Wind and/or Hail but Everest National Insurance Company has failed to extend coverage for repairs needed for the insured property. The Policy provides a Loss Settlement Provision.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Everest National Insurance Company (“Insurer”) issued an insurance policy bearing policy number CA4P000246211 with effective dates of coverage from January 1, 2021 - January 1, 2022, which insured the property located at 3700 Whitehall Drive, West Palm Beach, FL 33401. The policy was in effect when the property sustained damage on or about April 11, 2021, when damage was caused by Wind and/or Hail. received notice of the claim for property damage resulting from Wind, and related damages on or about April 11, 2021. The damage was reported to Insurer which assigned Claim Number 9-3285 to the claim and investigated the claim. Insurer alleged, after retaining an engineer and Young & Associates, that the damages did not exceed the deductible and were only short of $7,000. Insured retained a public adjuster, Ask an Adjuster, Inc. ("AAA") which assisted with the claim. AAA submitted to Insurer a phot report of damages, a storm report indicating winds up to 70 mph and 1 inch hail at the subject property on or about the date of loss, a tile report from Itel, Inc. indicating the non availability of the subject roof tiles indicating further replacement was needed, and an estimate of damages for $3,513,876.20 replacement cost value. Insured also submitted a Milestone Inspection Report, Pages 74, 75, 96, 106, 113, 115 & 122 in the Report include photographs that demonstrate the tiles cannot just be repaired, as there is rotted wood and damaged trusses that need replacement. The engineer that did the inspection is requiring Insured to repair/replace the roofs. Insured submitted a Sworn Proof of Loss ("POL") pursuant to the AAA Estimate. Insurer was provided the POL again on January 29, 2025 from Insured's counsel. Insurer has yet to respond. Insured's counsel also informed Insurer on February 21, 2025 of Insured's intent to repair the clearly damaged trusses. Insured provided previous roof permits for replacements and repair. Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured. Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy. This notice is being given in order to perfect the right to pursue the civil remedy authorized by this section.
Comments
User Id Date Added Comment
atyson@conroysimberg.com 04-18-2025 CRN RESPONSE We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Everest National Insurance Company’s Named Insured, Whitehall Condominiums of the Lands of the President Association, Inc., which was accepted by the Department of Financial Services on February 21, 2025, and assigned Filing No. 807958. The CRN revolves around a claim (Claim Number 9-3285) filed for alleged damage from a wind/hail storm that reportedly occurred on April 11, 2021 at the Insured’s condominium association located at 3700 Whitehall Drive, West Palm Beach, Florida 33401. The property consists of 14 four-story condominium buildings and a single-story clubhouse that were built in 1984 and are comprised of concrete tile roofs that were installed around 2001. At the time of loss, the Insured’s property was covered under Policy number CA4P000246-211, with each building subject to a separate schedule, issued by Everest National Insurance Company (“The Company”). At the outset, it should be stated that the CRN is defective and does not conform with the requirements of filing a CRN as it contains inaccurate factual allegations, lacks the required specificity and does not provide an opportunity for the Company to reasonably respond to the alleged violations contained in the CRN. The CRN merely contains conclusory reasons for the Notice, such as failing to settle claims in good faith, failing to implement standards for the proper investigation, and failing to acknowledge and act promptly upon communications, to name a few. For example, the Notice alleges that the Company violated the following statutory provisions of Florida Statutes §624.155: • §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all other 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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. The CRN fails to identify specific facts as related to the broad and conclusory allegations. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). Notwithstanding, the Company explicitly denies violations of any applicable Florida Statute in the adjustment of the referenced claims. The Company specifically denies that it has not attempted in good faith to settle the Insured’s claim when under all the circumstances it could and should have done so and it denies that it has failed to act fairly and honestly toward its Insured’s interests. Moreover, the Company specifically denies that it refused to properly investigate the claim or refused to tender all insurance proceeds without waiver of its objections, rights and defenses, the Company maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insured’s claim, and wishes to dispel even the inference of any violation, and reiterates below the reasons which clearly show the proper handling of the Insured’s claim. Additionally, the Civil Remedy Notice demands “cures” for the alleged defects that are improper under Florida case law. In Talat Enter., Inc., v. Aetna Cas. And Sur. Co., 753 So.2d 1278, 1281 (Fla. 2000), the Supreme Court of Florida held that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due to an insured. As a result, Everest National Insurance Company objects to the CRN as it is defective and should be rejected. In order to understand the deficiencies of this Notice, however, and reserving all objections to the subject CRN, the background of this case is necessary. On September 23, 2022, a public adjuster (“PA”) from Ask An Adjuster reported this claim on behalf of the insured as having occurred on April 11, 2021. The PA reported that a wind/hail storm caused damage to the roofs of the condominium buildings. The PA provided its letter of representation on September 23, 2022. It is important to note that from the start, Everest National Insurance Company (the “Company”) communicated with its Insured and/or its representatives on a regular basis. In fact, when the claim was reported on September 23, 2022, a first notice of loss letter acknowledging the claim was immediately sent out to the insured and its PA by letter dated September 28, 2022 advising the insured of its Bill of Rights as an Insured, and its pre-suit mediation opportunities. Further, later in the claim adjustment process, the Insured was advised of those same rights again, so it was very clear that the Insured was informed of what it could do to protect itself under the circumstances should it disagree with the Carrier’s handling and decision. On November 11, 2022, the PA submitted its estimate in the amount of $3,513,876.20 along with a Sworn Proof of Loss signed by the insured in the amount of the PA’s estimate. By letter dated November 23, 2022, the Company acknowledged receipt of the estimate and SPOL, and advised that its site inspection was scheduled to take place on November 30, 2022 and December 1, 2022. Given the fact that the Company had not completed a site inspection as of that time, the Company formally rejected the submitted Proof of Loss. Upon reporting of the loss, the Company retained an engineer from Thornton Thomasetti and a building consultant from Young & Associates. On November 30, 2022 and December 1, 2022, the Thornton Thomasetti and Young & Associates conducted joint inspection of the subject property with the insured’s PA. By letter dated May 30, 2023, the Company issued a coverage determination wherein the insured was advised that in review of the engineering report provided by Thornton Tomasetti, it was determined there was not widespread wind-related damage to the roofs throughout the subject property. In addition, it was concluded the localized areas of moisture infiltration are related to deferred maintenance. The Company advised that Thornton Tomasetti did advise that based on satellite imagery, the missing ridge and valley tiles at only 3 buildings (1, 10 and 14) were “localized” and could likely have been related to a wind related event. The Company explained that for all perils covered under the Policy, coverage afforded was subject to a $5,000.00 USD deductible per building, as well as a $5,000.00 USD for “other property”, such as trash enclosure buildings. The May 30th letter went on to advise that, after the joint inspection, Young and Associates prepared estimate of repairs on a “per building: and “per coverage” basis for all damages where “potential” wind damage could be confirmed. Based upon the foregoing, the Company advised it had determined that the claim for “potential” covered damage limited only to the tiles at three (3) buildings resulted in a net claim less deductible(s) of $6,808.13. The Company advised that the remaining claimed damage was not covered due to the policy provisions. Specifically, the Company explained that it was determined that the other claimed damage was not caused by a covered cause of loss or wind event, and, instead, it was the result of excluded causes including ongoing wear and tear, deterioration, and/or repeated seepage or leakage. Furthermore, the Company advised that the damage was the result of faulty, inadequate, or defective repair, construction, and/or maintenance, and, as such, there was no coverage for the claimed damage. With the May 30th coverage determination, the Company provided the insured with the Young & Associates estimate, statement of loss, and the applicable policy language clarifying the Company’s decision. On October 2, 2023, the PA submitted another SPOL, this time unsigned, in the same amount of the PA’s aforementioned estimate, $3,513,876.20. The PA then sent its previously submitted estimate again on November 30, 2023 along with a quote from a contractor in the amount of $3,843,090.00 and advised that the insured was seeking full roof replacement of the (3) subject buildings. By letter dated December 19, 2023, the Company acknowledged the unsolicited and unsigned proof of loss and advised that it would be holding the POL in abeyance while its investigation and review of the additional documentation submitted was concluded. By letter dated January 19, 2024, the Company issued a supplemental coverage position and claim status wherein the insured was advised that portions of the claimed damages to the roof, that were found to be unrelated to the wind event, were denied. The Company provided the following documents along with the January 19th letter: -Storm Report -Carrier Estimate -Site Map of the Property -Photograph Report -ITEL Report of Roof Tiles -PA Estimate -Contractor Proposal -Signed Proof of Loss The January 19th letter advised the insured of the following: “The previously mentioned documents were submitted by CTA to Everest National Insurance Company (Everest) and their retained subject-matter experts, Young & Associates (Y&A) and Thornton Tomasetti (TT). THORNTON TOMASETTI – DOCUMENT REVIEW The following documents were reviewed by TT for in connection with the claimed damages prepared by AAA: -Whitehall Condominiums of the Lands of the President Association Letter -Storm Report -Site Map of Property -Whitehall Claim Synopsis Report Based on review of TT’s document review, we understand that no additional information was provided which would alter or amend the original position taken by TT in review of the claimed damages. Additionally, TT is not in agreement with AAA’s stance that the roofs are not repairable and require complete replacement. Instead, repairs are possible through individual replacement of tiles from salvage tile suppliers, or through harvesting of tiles from sufficient roofing space on other buildings. We have included TT’s original reporting (Enclosure 1) with this report, as well as their supplemental report after review of additionally submitted documents (Enclosure 2) YOUNG & ASSOCIATES – DOCUMENT REVIEW The following documents were reviewed by YA for further review and consideration into the claimed damages prepared by AAA: -Storm Report -Carrier Estimate (YA Estimates for Building 1, 10, 14) -Site Map of Property -Whitehall Claim Synopsis Report -ITEL Report -AAA Estimate of Repairs -Contractor Proposal As YA’s estimate for roofing damages are based on the Scope of Work reviewed by TT, and there being no substantial change in Scope of Work based on documentation provided, there was not significant change within the estimation of damages by YA. However, it is important to note the following: -Based on the harvesting methodology outlined by TT in supplemental reporting, YA has produced an estimate of repairs which considers tile harvesting costs for Building 10’s trash receptacle, which allows for more than enough tiles to cover the wind damage tiles found through Buildings 1 – 14 where damages were identified. -Upon review of AAA’s estimate, YA confirmed that there are damages within their own estimate of repairs based on wind-related damages that are not present within AAA’s estimate. We have included YA’s analysis report (Enclosure 3) within this report for your review and consideration. CURRENT MEASUREMENT Everest and CTA have reviewed the claim file as well as the calculated damages based on the understanding of the reporting prepared, and submitted by, retained engineering, and building consultant experts, TT and Y&A. Additionally, upon our own internal review of the file and review of the additional submissions from TT and Y&A, we have re-calculated the damage measurement as outlined on the Statement of Loss. (Enclosure 4). Please note that the current measurement of damages as outlined in the enclosed Statement of Loss and net of the Policy deductible(s) equals $20,892.06. GROSS DAMAGES (BEFORE DEDUCTIBLES): $75,468.32 NET DAMAGES (AFTER DEDUCTIBLES): $20,892.06 LESS PRIOR PAYMENTS: $6,808.13 NET CLAIM: $14,083.93 PAYMENT DIRECTIVES Payment will be issued in the net claim amount as outlined prior in the amount of $14,083.93. All other claimed damages to the roof and interior not included in our enclosed repair estimate were found to not have been a result of a covered cause of loss or wind event. The roofs were in generally fair condition, however there were a limited number of cracked tiles. The cracks consistently originated from the corners, there was no evidence of impact from wind-driven debris at these tiles. Mortar around the plumbing ventilation pipes was typically cracked and/or separated. The non-wind related damages were a result of excluded causes including ongoing wear and tear, deterioration, and/or repeated seepage or leakage. Furthermore, the damage was a result of faulty, inadequate, or defective repair, construction, and/or maintenance. Accordingly, there is no coverage for those claimed damages. CLOSING STATEMENTS As you are aware, our current measurement of damage varies greatly from that of AAA. We ask that AAA take close review to reporting from TT and Y&A regarding the Underwriter’s measurement of damages and understand the significant deficiencies with the presented damages from an overall coverage standpoint.” The insured then retained counsel who provided a letter of representation on January 29, 2025, and enclosed the insured’s proof of loss in the amount of $3,513,876.20. Counsel then filed the Civil Remedy Notice with the Department on behalf of the Insured on February 21, 2025. Later, counsel filed a Notice of Intent to Initiate Litigation on April 14, 2025. The Insured’s counsel complains that there is a disagreement as to scope and pricing in this case, among other items. While that might be true, that does not rise to the level of a statutory violation, it is merely a disagreement with the value of the loss. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. Everest National Insurance Company has communicated with its Insured and its representatives as required. Everest National Insurance Company has inspected the loss and damages thoroughly and given a thorough assessment of its findings and conclusions made. The fact that Everest National Insurance Company was not in agreement with the position of the Insured or its representatives and the estimates prepared on its behalf, does not rise to the level of statutory violations. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. As demonstrated above, the Company has, thus far, undertaken a thorough adjustment process and investigation, and the decision that it has made as to what is compensable and what is not has been amply explained to the Insured. The Company has, at all times, acted fairly and promptly toward its Insured and with full regard to its interests, and has complied with its obligations in this claim process. Any further information which may be required is available upon request.
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