Civil Remedy Notice of Insurer Violations
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Filing Number:     808023
Filing Accepted:  2/24/2025
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Complainant
Last/Business Name *  
SEARS AUTO SOLUTIONS LLC   First Name  
Street Address * 4900 49TH ST N
City, State Zip * SAINT PETERSBURG, FL 33709
Email Address * THOM@PRINCIPLECAP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SEARS AUTO SOLUTIONS LLC   First Name  
Policy # * AML002280 Claim #* 250230
Attorney
Attorney is Applicable
Last Name* GORDON First Name * BRENT Initial
Street Address* PO BOX 599
City, State Zip* LUTZ , FLORIDA 33548
Email Address * BG@THEGORDONFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNDERWRITERS AT LLOYD'S, LONDON
NAIC Company Code
 
Name of individual responsible for violation (if any):* JUSTIN MANAHAN, MATT HEIDINGER, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY CERTAIN UNDERWRITERS AT LLOYD’S, LONDON, INC. INVOLVED IN THE CLAIM
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Failure to properly investigate claim and with due regard to Insured’s interest
Other : Failure to acknowledge and act promptly to communications regarding claim
* 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)(2) A material misrepresentation made 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.
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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

2. Appraisal If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss. In their event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim.
 
* 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. Certain Underwriters at Lloyd’s, London has breached their duty by its failure or refusal to acknowledge its Insured’s claim of loss dispute options. Lloyd’s Insurance has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations as set forth above. Lloyd’s Insurance has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. To date, notwithstanding the Insured’s pleas, Certain Underwriters at Lloyd’s, London has continued to refuse to acknowledge its obligation to acknowledge and pay the full amount of its Insured’s claim. Their complaint is made on behalf of the Insured, Sears Auto Solutions LLC. Further, their complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155. In consideration of the premium paid to it by Sears Auto Solutions LLC issued a Homeowners policy, Policy No AML002280 (hereinafter referred to as “the Policy”), to Sears Auto Solutions LLC wherein the insurance policy provided coverage for all losses, including water, except those losses which were expressly excluded. The policy was in full force and effect at the time the damage occurred as a result of a hurricane, and the ensuing damages as a direct result thereof, to the insured premises located at 4900 49th St N. Saint Petersburg, FL 33709, on or about September 26th, 2024. Sears Auto Solutions LLC insured property sustained damage to the interior and exterior of the building, including the roof system. On the roof, Sears Auto Solutions LLC insured property had damage, including but not limited to, the flashing, vents, pipes, sheathing, fascia, drip edge, gutters, decking, etc. On the interior, Sears Auto Solutions LLC property sustained damage, including but not limited to, the insulation, drywall, paint, ceiling panels, tile walls etc. in the main office, front entry, bathrooms (2), service bays, storage areas, etc. Indra Sears, owner of Sears Auto Solutions LLC timely notified Certain Underwriters at Lloyd’s, London of the damages and opened a claim pursuant to the terms and conditions of the Policy. In response, Certain Underwriters at Lloyd’s, London assigned the claim to its representative, Justin Manahan of Capstone ISG, who is a third party TPA firm handling claims for the insurance carrier,, Florida License Number P160841, to adjust and investigate the loss, as well as a field adjuster, Matt Heidinger FL Adjusters License W282967, to inspect the damages. Certain Underwriters at Lloyd’s, London representative, Matt Heidinger, visited the insured property and performed a cursory and inadequate investigation of the damaged property. Concerned that Certain Underwriters at Lloyd’s, London had no intention of fairly investigating and adjust their claim, Mr. Buck retained the services of an insurance claim professional, Brian Canfield from Dependable Resolutions, LLC. (Dependable Resolutions), to assist in submitting their claim to Certain Underwriters at Lloyd’s, London, which would adequately and fairly detail all the damage sustained as a result of the loss. In contrast to the Certain Underwriters at Lloyd’s, London inspection estimate, Sears Auto Solutions LLC inspection estimate from Dependable Resolutions, was inclusive of the full extent of damage sustained to their insured property, as detailed above. Their estimate totaled a Building damage to $ 657,419.78 RCV, contents damages of $2,002.24 and Loss of Use damage, including repair time in the amount of $75,000.00. Certain Underwriters at Lloyd’s, London damage estimate was extremely deficient, as it was undervalued in overhead, profit, replacement of the entire roof system, and interior contents manipulation, etc. On November 5th, 2024, Certain Underwriters at Lloyd’s, London submitted a Partial Payment/Denial Letter to Sears Auto Solutions LLC for $34,331.28 for Dwelling damages (Coverage – A). Certain Underwriters at Lloyd’s, London also stated we also observed evidence of termite damage in the office/reception area and ponding on the rear attached roof, which has resulted in pre-existing water damage to the sheathing, where no Storm-created opening was apparent, neglecting that the entire roof system was compromised by the Category 4 hurricane with winds in excess of 135 MPH. Unable to wait any longer for Certain Underwriters at Lloyd’s, London to offer full-owned insurance benefits, Mr. Buck has installed a watertight barrier on the roof system of their insured property, in an effort to prevent additional damage. Certain Underwriters at Lloyd’s, London, claim determination process has been misrepresented in damage values and has been delayed in owed insurance benefits to Sears Auto Solutions LLC. Note that on December 20th, 2024, Sears Auto Solutions LLC had invoked its right to appraisal, as outlined in the policy with Certain Underwriters at Lloyd’s, London. The appraisal process is a standard procedure when there is a dispute between the parties about the value of the property or the amount of loss. According to the policy, both parties are entitled to choose a competent and impartial appraiser, and if they cannot agree on an umpire, a judge may make the selection. The final decision, made by the two appraisers or by a decision from the umpire, is binding, and both parties bear the associated costs equally. The issue raised here is the denial of rights by Certain Underwriters at Lloyd’s, London. If they are denying Sears Auto Solutions LLC’s right to proceed with the appraisal or their rights under the policy, they would need to provide a justifiable reason, and failure to do so could potentially constitute bad faith in handling the claim. To date, Sears Auto Solutions LLC has not received any reinspection offers from Certain Underwriters at Lloyd’s, London To date, Sears Auto Solutions LLC has not received any settlement offers from Certain Underwriters at Lloyd’s, London. To date, Certain Underwriters at Lloyd’s, London has failed to tender any supplemental insurance benefits. Certain Underwriters at Lloyd’s, London has admitted that Sears Auto Solutions LLC sustained covered damages as a result of the water loss that occurred on or about September 26, 2024 but has denied tendering all owed insurance benefits to Sears Auto Solutions LLC. Pursuant to Florida Statute §626.9541(1)(i)(4), Certain Underwriters at Lloyd’s, London is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after Certain Underwriters at Lloyd’s, London received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). As Certain Underwriters at Lloyd’s, London has failed to do so, Certain Underwriters at Lloyd’s, London has wrongfully denied coverage. Since the beginning of the claim, Certain Underwriters at Lloyd’s, London has engaged in a pattern of delay, denial, and reckless disregard for Sears Auto Solutions LLC rights. The actions of Certain Underwriters at Lloyd’s, London listed herein have been continuing in nature and given the totality of the circumstances, which includes Certain Underwriters at Lloyd’s, London adjustment, actions and/or omissions post the filing of their CRN. Sears Auto Solutions LLC contends that given the past experience in their matter with Certain Underwriters at Lloyd’s, London, it is reasonably foreseeable that Certain Underwriters at Lloyd’s, London current actions will extend to its entire conduct in the handing of their claim, including the acts or omissions of Certain Underwriters at Lloyd’s, London and/or its representatives, until the final resolution of their claim. As such, Sears Auto Solutions LLC contends adequate notice has been given should Certain Underwriters at Lloyd’s, London actions and violations listed herein continue after the expiration of their notice. Certain Underwriters at Lloyd’s, London has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards Sears Auto Solutions LLC and has failed to take into account the information and evidence provided that contradict its decisions. Even upon receipt of additional and supporting evidence to the contrary, Certain Underwriters at Lloyd’s, London has continued to stand by its claim denials. As such, Sears Auto Solutions LLC does not anticipate Certain Underwriters at Lloyd’s, London will rescind its partial denial of their claim. Certain Underwriters at Lloyd’s, London conduct has been reckless and unfair to Sears Auto Solutions LLC and has caused and continues to cause additional damage throughout the property. Their is evidenced by the delay in paying the claim and the failure of Certain Underwriters at Lloyd’s, London, to evaluate the claim in total. To date, Certain Underwriters at Lloyd’s, London, has failed and/or refused to provide Sears Auto Solutions LLC with all the insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that Sears Auto Solutions LLC has sustained covered damage to their insured property. As Certain Underwriters at Lloyd’s, London must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. Certain Underwriters at Lloyd’s, London is bound to conduct itself with the utmost good faith for the benefit of Sears Auto Solutions LLC. However, Certain Underwriters at Lloyd’s, London has failed to comply with the obligations in connection with their claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, Certain Underwriters at Lloyd’s, London, has looked for ways not to pay the claim in full, or at all, and these actions have been to the detriment of Sears Auto Solutions LLC. The adjusters assigned to their claim have a duty to adjust and treat all claims equally. Since the beginning of their claim the representatives on behalf of Certain Underwriters at Lloyd’s, London have approached their investigation in a manner prejudicial to Sears Auto Solutions LLC. Certain Underwriters at Lloyd’s, London, is using either untrained or improperly trained adjusters in connection with their claim. Certain Underwriters at Lloyd’s, London, should have been adjusting the loss with Sears Auto Solutions LLC but instead, it was looking for ways not to pay the claim at all, or pay the claim in full. If Certain Underwriters at Lloyd’s, London handles all the claims in the manner in which Sears Auto Solutions LLC claim was adjusted, then it is improperly handling all claims. HOMEOWNERS CHOICE has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, Certain Underwriters at Lloyd’s, London was to timely tender undisputed insurance benefits to Sears Auto Solutions LLC. Certain Underwriters at Lloyd’s, London has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. Their is a breach of The Policy. Certain Underwriters at Lloyd’s, London has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with Sears Auto Solutions LLC during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. Their is a breach of The Policy. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that Sears Auto Solutions LLC may mitigate their damage and to put him back into the position he was in prior to the loss as quickly as possible. Certain Underwriters at Lloyd’s, London has breached their duty. Certain Underwriters at Lloyd’s, London has refused and/or failed to tender all insurance proceeds to Sears Auto Solutions LLC upon demand. Certain Underwriters at Lloyd’s, London refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards Sears Auto Solutions LLC is wrongful conduct. Furthermore, Sears Auto Solutions LLC contends that Certain Underwriters at Lloyd’s, London adjusters and/or representatives financially benefit from such wrongful conduct. It is clear that Certain Underwriters at Lloyd’s, London adjusters, have also failed to adhere to insurance industry rules and guidelines when adjusting a first party claim. It is also evident that Certain Underwriters at Lloyd’s, London violated the Florida unfair claims practices, the adjuster’s ethical code of conduct, and acted irresponsibly in the handling of its insured’s claims. In their case, Sears Auto Solutions LLC paid a hefty premium for a service, the service is called claims adjusting (I encourage you to read the book titled, “The Claims Environment” written by James J. Markham, Kevin M. Quinley, and Layne S. Thompson-their book is taught in every first year AIC course). The claim professional must dispense their or her knowledge and skill for the benefit of society. The general public expects claims representatives to pay all legitimate claims promptly and fairly. The claim professional must harness all of their or her knowledge and expertise to accomplish the objectives of the claim function. He or she must also adhere to the highest degree of ethical conduct. In addition to interacting with other insurance personnel and service providers in a professional manner, the claims professional must deal with public and regulator’s expectations. Insurance Companies provide such a vital and necessary service to society that the selling and servicing of insurance is imbued with public trust. James J. Markham, Kevin M. Quinley, Layne S. Thompson, “The Claims Environment”, Insurance Institute of America, 1st ed., 1993. Accordingly, Certain Underwriters at Lloyd’s, London has a contractual and statutory obligation to investigate all possible bases which might support Sears Auto Solutions LLC claim and cannot deny a claim without thoroughly investigating the foundation for its denial or basis for withholding insurance benefits. Certain Underwriters at Lloyd’s, London violated its obligations here. - Certain Underwriters at Lloyd’s, London has a contractual and statutory obligation to make a perfunctory investigation, not ignoring evidence that would support Sears Auto Solutions LLC claim. Certain Underwriters at Lloyd’s, London violated its obligations here. - Certain Underwriters at Lloyd’s, London has a contractual and statutory obligation not to look the other way when confronted with facts revealing the possibility of coverage and resisting reasonable interpretations of its policy. Certain Underwriters at Lloyd’s, London violated its obligations here. - Certain Underwriters at Lloyd’s, London has a contractual and statutory obligation not to deny the claim based on standards known to be impermissible or on an interpretation contrary to established law. Certain Underwriters at Lloyd’s, London violated its obligations here. These actions and violations were either done intentionally or as the result of Certain Underwriters at Lloyd’s, London failure to adopt and implement the proper standards of the investigation and adjustment of claims. Overall, Certain Underwriters at Lloyd’s, London investigation of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law. Sears Auto Solutions LLC has done everything legally requested by Certain Underwriters at Lloyd’s, London to date. To cure the violations set forth in their Civil Remedy Notice, Certain Underwriters at Lloyd’s, London must now agree to acknowledge its duties and obligations under the law in adjusting its insured’s claim, and tender rightfully owed insurance benefits to return Sears Auto Solutions LLC to their pre-loss condition. Further, to cure the violations set forth in their Civil Remedy Notice, Sears Auto Solutions LLC hereby requests that Certain Underwriters at Lloyd’s, London tender at their time, or prior to the expiration of the statutory cure period, the amount of Sears Auto Solutions LLC damage estimate and demand which accurately reflects the true nature and extent of Sears Auto Solutions LLC damages. Therefore, Certain Underwriters at Lloyd’s, London should tender $ 734,422.02 (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at their time. Although Sears Auto Solutions LLC has made a demand for payment in the amount of $ 734,422.02 (less any prior payments, depreciation, excess policy limits, and/or deductible) and has provided Certain Underwriters at Lloyd’s, London with all the necessary documentation in support thereof, he is still willing to consider and to potentially accept any reasonable counter-offer made by Certain Underwriters at Lloyd’s, London. Therefore, if Certain Underwriters at Lloyd’s, London is not in agreement with Sears Auto Solutions LLC reasonable demand for payment of their rightfully owed insurance benefits being submitted at their time, Sears Auto Solutions LLC hereby requests that Certain Underwriters at Lloyd’s, London, now make a reasonable counter-offer before the expiration of the cure period. Sears Auto Solutions LLC still hopes that their claim can be resolved amicably. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that Sears Auto Solutions LLC may mitigate their damage and to put him back into the position he was in prior to loss as quickly as possible. Certain Underwriters at Lloyd’s, London breached their duty. Their notice is given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155, including any and all bad faith/extra contractual, should Certain Underwriters at Lloyd’s, London fail to cure the violations set forth in their Civil Remedy Notice within the given cure period. While no specific “cure amount” is required for their Civil Remedy Notice to be valid, Sears Auto Solutions LLC will consider the allegations contained herein “cured” if Certain Underwriters at Lloyd’s, London, without any requirement for a release: (1) Immediately tenders the amount of Sears Auto Solutions LLC damage estimate in the amount of $ 734,422.02 (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damage to the Dwelling / Other Structures; (2) Agrees to reimburse Sears Auto Solutions LLC for their expenses incurred by having to retain a public adjuster to present theirclaim; and (3) Immediately tenders the amount of statutory interest due and owing Sears Auto Solutions LLC pursuant to Florida Statute §627.70131(5)(a). (4) Immediately provides Sears Auto Solutions LLC with the documentation Certain Underwriters at Lloyd’s, London has used and/or continues to contend, supports the claim determination made by Certain Underwriters at Lloyd’s, London in the adjustment of Sears Auto Solutions LLC claim. Specifically, Certain Underwriters at Lloyd’s, London must provide Sears Auto Solutions LLC with its claim estimate(s), supporting photographs and/or videos, as well as any and all reports of any expert(s) or other individuals retained on behalf of Certain Underwriters at Lloyd’s, London upon which Certain Underwriters at Lloyd’s, London has relied on in reaching and/or further supporting its coverage determination in Sears Auto Solutions LLC claim. Sears Auto Solutions LLC continues to remain open to a fair and reasonable settlement offer from Certain Underwriters at Lloyd’s, London in an effort to avoid additional delay, costs and expenses, and hereby request the same prior to the expiration of the statutory “cure” period. Sears Auto Solutions LLC has provided Certain Underwriters at Lloyd’s, London with all necessary estimates, documentation, etc. in support of the claim. Certain Underwriters at Lloyd’s, London must act fairly and honestly in its response to Sears Auto Solutions LLC request for a prompt, fair and reasonable settlement offer and resolution of the claim.
Comments
User Id Date Added Comment
ccapeles@wshblaw.com 04-23-2025 We write on behalf of Underwriters at Lloyd's, London, Subscribing to Policy No. AML002280 (hereinafter referred to as "Underwriters") in response to the Civil Remedy Notice of Violation bearing DFS File No. 808023 (the "Notice") filed by Sears Auto Solutions LLC (the "Insured" or Complainant”) in connection with reported damage to the property located at 4900 49th St N, Main Bldg 2, Saint Petersburg, FL 33709 (the "Property") due to Hurricane Helene. Underwriters subscribed to Policy No. AML002280 issued to the Insured for the policy period of July 18, 2024 to July 18, 2025 (the "Policy"). The Notice bears a filing acceptance date of February 24, 2024, making this response due on or before April 25, 2024. While Underwriters welcome the opportunity to respond to this Civil Remedy Notice of Insurer Violations and specifically deny each and every allegation contained in the Civil Remedy Notice filed in relation to this claim, Underwriters believe that the Civil Remedy Notice should be deemed deficient as it fails to comply with the specific information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions as set forth in section 624.155, Florida Statute and Florida case law. Notwithstanding the fact that the Notice is deficient for the reasons stated below, Underwriters respectfully submit that they have not acted in bad faith. To the contrary, Underwriters have acted at all times in good faith and applied the terms of coverage as clearly and unambiguously as stated in the Policy. I. THE NOTICE IS LEGALLY DEFICIENT. As a preliminary matter, in the "Notice Against" section, the Notice names "Underwriters at Lloyd's, London." This is insufficient to provide Notice to a member of the London insuring market. It does not specify to which member of the Market the Notice applies. The use of the generic description "Underwriters at Lloyd's, London" is insufficient under Florida law. Underwriters reserve all rights regarding this issue. Second, in the Notice's "Notice Against" section, the Complainant wrongfully identifies the type of insurer the Complainant is filing the Notice against. Specifically, the Complainant identifies Underwriters as an "Authorized Insurer." This is inaccurate. Contrary to Complainant's allegations in the Notice, Underwriters are not an "Authorized Insurer" under Florida law. Rather, Underwriters are a collection of unauthorized insurance syndicates who subscribe to insurance policies issued to Florida citizens via qualified and licensed “surplus lines agents.” See § 626.913(2), Fla. Stat. (2008). Notably, the Notice misidentifies the type of insurer the Complainant filed the Notice against. This misidentification does not comply with requirements of Fla. Stat. § 624.155, Florida Administrative Code 69J-123.002, or DFS Form DFS-10-363, further rendering the Notice defective. Additionally, the Notice also fails to state with specificity the facts and circumstances giving rise to the alleged violations, as required by section 624.155. Moreover, the Notice misrepresents the actual facts of this claim and omits relevant facts that demonstrate how Underwriters properly and efficiently adjusted this claim. Section 624.155 mandates that a notice "shall state with specificity . . . the facts and circumstances giving rise to the violation" (emphasis supplied). Additionally, a "civil remedy notice must be specific enough to provide the insurer notice of the wrongdoing so that insurer can cure the same within sixty days." See Section 624.155. Here, the Notice fails to state with specificity the facts and circumstances giving rise to the alleged violations. The Complainant alleged eight (8) separate statutory violations; however, the Complainant fails to link the alleged statutory violations to any facts that would support the claim that Underwriters violated those statutes. Instead, the Complainant generally states that violations of these statutes occurred but provide nothing to substantiate these conclusory claims other than general allegations. The Notice also fails to set forth any specific policy language relevant to the purported violations as required by section 624.155(3)(b)(4), Fla. Stat. This failure to identify the specific language in the referenced policy provisions allegedly relevant to the purported violations prevents Underwriters from addressing any issues regarding the policy and is another reason why the Notice does not comply with section 624.155. The Notice provides a series of unsupported blanket conclusory allegations about Underwriters' practices. The Notice alleges that Underwriters did not attempt "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 or his interests." The Notice also alleges Underwriters failed to promptly settle claims. In addition, the Notice alleges that Underwriters made material misrepresentation to an Insured for the purpose of effecting settlement. In contrast, Underwriters have consistently handled claims with good faith throughout the state of Florida. Next, the Notice alleges that Underwriters failed to "adopt and implement standards for the proper investigation." Moreover, the Notice alleges Underwriters misrepresented facts of insurance policy provisions related to coverages at issue and denied claims without conducting reasonable investigations based upon available information. Additionally, the Notice alleges Underwriters failed to "act promptly upon communication with respect to claims and that Underwriters failed to "provide a reasonable explanation in writing to the Insured" and failed to pay undisputed amounts of partial or full benefits owed and engaged in unfair claims settlement practices. However, the Complainant fails to state with specificity how Underwriters have violated the alleged statutes where Underwriters' have performed a proper investigation, issued a coverage determination letter on November 5, 2024, providing details of Underwriters' investigation, and also issued corresponding payment to the Insured for covered damaged. In sum, the Notice does not provide any details as to how Underwriters allegedly violated these statutes. This accusatory language prejudices Underwriters and provides no actual factual support for the Notice's conclusory allegations. As a result, the Notice is wholly insufficient (and incorrect). Instead of providing Underwriters with actual notice of the Complainant's concerns about the claim, the Notice is essentially a "shotgun-blast effort to hit a lot of targets with a single salvo." Rousso v. Liberty Surplus Insurance Corp., 2010 WL 7367059 at *5 (S.D. Fla. 2010). This type of approach is disfavored by Florida courts because it is contrary to the purposes of Section 624.155. "The civil remedy notice must reflect a good-faith effort to inform the insurer of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings. The civil remedy notice is not the place for posturing or advocacy, and an effort to overstate a claim in a civil remedy notice may end up undermining it." Id. As a result of the "shotgun-blast approach" taken with respect to this Notice, Underwriters are left without reasonable means to respond to the alleged violations. Finally, the Notice should be deemed deficient because it does not provide Underwriters with a reasonable opportunity to "cure" the alleged defects. Section 624.155 mandates that "[n]o action shall lie if, within sixty days after filing notice, the damages are paid or the circumstances giving rise to the violation are corrected." (emphasis supplied). The Florida Legislature enacted the sixty-day cure window to provide "a last opportunity for insurers to comply with their claim-handling obligations." 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1192 (N.D. Fla. 2008) (quoting Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000)). "[T]he purpose of the civil remedy notice is to give the insurer one last chance to settle the claim with its insured and avoid unnecessary bad faith litigation." 316, Inc., 625 F. Supp. 2d at 1192. The Notice states that to cure, the Complainant requests Underwriters: (1) Immediately tenders the amount of Sears Auto Solutions LLC damage estimate in the amount of $734,422.02 (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damage to the Dwelling / Other Structures; (2) Agrees to reimburse Sears Auto Solutions LLC for their expenses incurred by having to retain a public adjuster to present their claim; and (3) Immediately tenders the amount of statutory interest due and owing Sears Auto Solutions LLC pursuant to Florida Statute §627.70131(5)(a). (4) Immediately provides Sears Auto Solutions LLC with the documentation Certain Underwriters at Lloyd’s, London has used and/or continues to contend, supports the claim determination made by Certain Underwriters at Lloyd’s, London in the adjustment of Sears Auto Solutions LLC claim. Specifically, Certain Underwriters at Lloyd’s, London must provide Sears Auto Solutions LLC with its claim estimate(s), supporting photographs and/or videos, as well as any and all reports of any expert(s) or other individuals retained on behalf of Certain Underwriters at Lloyd’s, London upon which Certain Underwriters at Lloyd’s, London has relied on in reaching and/or further supporting its coverage determination in Sears Auto Solutions LLC claim. The Notice further provide that Underwriters should tender $734,422.02 (less any prior payments, depreciation, excess policy limits, and/or deductible) to the Complainant in order to cure the deficiencies alleged in the Notice. The cure demand therefore requires Underwriters to exceed its obligations under the insurance contract and law. Notably, an insurer can only be required to take curative action that is within the terms of the subject policy. As such, the Notice is legally deficient and should be rejected because it denies Underwriters a reasonable opportunity to “cure” the defects alleged, in plain contravention of well-settled Florida law. To the extent that any other allegations within the Notice have not been specifically addressed in this response, Underwriters deny any and all allegations contained in the Notice. Underwriters deny that they have violated any Florida Statutes, Administrative codes, Code of Ethics, or any provisions of the Policy. II. UNDERWRITERS ACTED IN GOOD FAITH. In the event that the Notice is not deemed deficient for the reasons laid out above, Underwriters deny that they have acted in bad faith or violated any of the statutes referenced in the Notice. To the contrary, Underwriters have, at all times, acted in good faith and with due consideration of their Insured's interests regarding this claim. Underwriters resolved the Insured's claim as expeditious as possible and in accordance with the terms of coverage afforded by the Policy. The Insured reported a claim on September 27, 2024, alleging damages to the Property caused by Hurricane Helene. Underwriters promptly engaged Capstone ISG (“Capstone”) as the third-party administrator, who assigned an independent adjuster to inspect the Property on October 4, 2024. The adjuster’s inspection identified covered damages related to Hurricane Helene, including damage to the main roof and interior of the main building. However, the adjuster also observed pre-existing conditions, including visible signs of pooling water on the rear roof predating the loss, which contributed to pre-existing water damage to the sheathing with no storm-created opening evident. Additionally, termite damage was noted in the office/reception area, which is not covered under the Policy. Based on these findings and the Policy provisions, Underwriters issued a coverage determination letter on November 5, 2024, outlining the scope of covered damages and issuing a net payment of $34,331.28 for Hurricane Helene-related damage. Additionally, Underwriters issued a supplemental coverage letter confirming coverage for tarping services provided by Roof X Inc. (“Roof X”) on October 1, 2024, and for resetting the tarp on October 19, 2024, despite the latter service being necessitated by Hurricane Milton. A supplemental net payment of $12,122.99 was issued for these services, reflecting Underwriters’ commitment to addressing covered losses promptly. On December 11, 2024, the Insured submitted a supplemental claim through their public adjuster, Dependable Resolutions LLC, presenting an estimate totaling $734,422.02. This estimate significantly exceeds the scope of the original adjustment and includes $657,419.78 for Building damages, $2,002.24 for Contents damages, and $75,000.00 for Loss of Use/Business Income. Notably, the estimate lacks supporting documentation for the Contents claim and the alleged Business Income loss. Underwriters further note that the Policy provides coverage limits of $650,000 for Building Coverage and $45,000 for Business Income with Extra Expense, which underscores the need for substantiation of the Insured’s claims, particularly given their valuation exceeds these limits. Subsequently, the Insured invoked appraisal for the claim. However, the submission of this new estimate, which introduces a substantially expanded scope of damages and an unsubstantiated business income claim, renders the demand for appraisal premature. Underwriters are actively investigating the supplemental claim to ensure all relevant information is considered in accordance with the Policy. The appraisal process is not appropriate at this stage, as it requires a clear agreement on the scope of covered damages, which cannot be established without further evaluation of the Insured’s newly presented claims and supporting documentation. In a good faith effort to fully understand the Insured’s supplemental claim, Underwriters requested a joint inspection of the Property with engineers and estimators and an Examination Under Oath (EUO) of the Insured’s representative. On March 4, 2025, Underwriters’ building consultant and engineer conducted an inspection, and the findings are currently under review. Additionally, Underwriters’ counsel has been in communication with the Insured’s counsel to schedule the EUO at a mutually agreeable time. Despite Underwriters’ document request letter, the Insured has provided only limited documentation related to the business income claim, and critical records—such as those reflecting incurred expenses or substantiating the scope of the alleged Contents and Business Income losses—remain outstanding. Underwriters are committed to working collaboratively with the Insured to resolve these issues and have provided regular updates, including a status letter issued on April 11, 2025, detailing the ongoing investigation of the supplemental claim. Underwriters' adjustment of this claim is ongoing, but requires the Insured’s and its counsel’s cooperation. Underwriters continue to investigate this claim in good faith. Underwriters will promptly pay any undisputed amounts determined as owed to the Insured as a result of their continued investigation. In sum, Underwriters adjusted the claim diligently, promptly and properly. Specifically, Underwriters have not violated statute 624.155(1)(b)(1), as alleged in the Notice because Underwriters sent an adjuster to the property in order to investigate the claim and to determine the extent of the alleged damages associated with the subject claim and retained additional experts to further investigate the Insured's supplemental claim. Moreover, Underwriters have not violated statutes 626.9541(1)(i)(3)(a) or 626.9541(1)(i)(3)(b) as Underwriters did not fail to adopt and implement standard for the proper investigation of claims nor have Underwriters mispresented any information or Policy provisions to the Insured or any other person having an interest in the proceeds under the policy. Additionally, Underwriters have not violated Florida Statutes 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(4)or 624.155(1)(b)(3) as alleged in the notice because Underwriters conducted a thorough investigation of the claim based upon the information provided and timely issued an initial coverage determination letter based on the independent adjuster's inspection and the applicable policy’s conditions and exclusions. In addition, payments were issued to the Insured based on Underwriters' investigation. Further, Underwriters have not violated 626.9541(1)(i)(2) as no material misrepresentation have been made to the Insured or any other person having an interest in the subject claim. Underwriters denies that is has violated any Florida Statutes, Administrative Codes, or any provisions of the Policy. As drafted, the Notice is essentially a contention that Underwriters acted in "bad faith" because it did not pay what the Complainant believed they were owed. This is not "bad faith," and out of step with the governing law and purpose behind the Civil Remedy Notice practice. See 316, Inc., 625 F. Supp. 2d at 1194. "An insurer that denies payment on a claim is not guilty of bad faith as a matter of law." Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla. 2000). Instead, “[t]he insurer has a right to deny claims that it in good faith believes are not owed on a policy.” Id. A good faith denial precludes liability “[e]ven when it is later determined by a court or arbitration that the insurer . . . was mistaken.” Vaughn v. Producers Agriculture Ins. Co., 111 F. Supp. 3d 1251, 1259-60 (N.D. Fla. 2015). Underwriters specifically deny that they acted in bad faith simply because it has not paid the Insured what the Insured believes they are owed in this claim. To the contrary, Underwriters respectfully submit that they adjusted this claim in accordance with the applicable policy provisions and the laws of Florida and have acted in good faith throughout the entire investigation of this claim. For the reasons stated above, Underwriters assert that the Notice is legally deficient. Additionally, Underwriters respectfully emphasize that they have done nothing other than act in utmost good faith and applied the terms of coverage as clearly and unambiguously stated in the Policy. Florida law is clear that an insurer has the right to investigate claims presented for payment and is expressly afforded an opportunity to evaluate its rights and liabilities. See 316, Inc. V. Maryland Cas. Co., 625 F.Supp.2d 1187, 1192 (N.D. Fla. 2008) (quoting Talat Enters., Inc. V. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000)). Underwriters vehemently deny that they have acted in bad faith and denies that they have violated any Florida Statutes, Florida law, Administrative Codes or any provisions of the subject Policy of insurance.
bg@thegordonfirm.com 02-25-2025 Hi, Upon further review and contact from the referenced Insurer name below, this notice is withdrawn without prejudice to confirm the proper insurer that should be the subject of the dispute. Thank you, Brent Gordon
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