Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 808101

Filing Accepted: 2/24/2025

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Complainant

Last/Business Name *

WALSH

First Name

LORRAINE AND JOHN

Street Address *

300 OAK HAVEN DRIVE

City, State Zip *

MELBOURNE, FL 32940

Email Address *

JACKW6810@MSN.COM

Complainant Type: *

Insured

Last/Business Name*		WALSH		First Name		LORRAINE AND JOHN
Policy # *		HCPC-H03-492971-3		Claim #*		920985

Attorney

Attorney is Applicable

Last Name*	ELAZAR First Name * SAPIR Initial
Street Address*		800 EAST BROWARD BLVD. SUITE 510
City, State Zip*		FORT LAUDERDALE , FLORIDA 33301
Email Address *		SE@WEKLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

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
	Claim Denial

* 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)(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.

Loss Payment Provision. 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.

John Walsh and Lorraine Walsh (the "Insureds") purchased an insurance policy ("Policy") from Homeowners Choice property & Casualty Insurance Company, Inc. ("Homeowners Choice"), with effective coverage on the date of the loss, on or about March 16, 2022, and policy number HCPC-H03-492971-3 to insure their home located at 300 Oak Haven Dr., Melbourne, FL 32940 (the "Property"). On or about March 16, 2022, the Property suffered severe damage as the result of a windstorm, which caused damage to the roof and interior of the Property. The Insureds promptly reported the claim to Homeowners Choice. Homeowners Choice acknowledged receipt of the claim by generating claim number 920985. As required, Homeowners Choice went to inspect the property and generated an estimate for the damage suffered. Homeowners Choice made a low-ball coverage decision that broadly ignored the damage sustained to the Property valuing the damage at $1,294.86. It was clear that Homeowners Choice was trying to reduce their contractual obligation by undervaluing the damage to the Insureds property from the start, even though the Insureds actively provided all proof of claim needed to have his claim evaluated fairly. Despondent, the Insureds retained AskAnAdjuster (AAA) to act as their public adjuster and representative, to assist in the evaluation and inspection of damage to the property. Eco Restore investigated the property and generated an estimate for the damage. AAA timely sent their estimate to Homeowners Choice, which estimated the scope or damage to be $96,571.00, almost 95 times more than the evaluation made by Homeowners Choice. Homeowners Choice’s dramatically insufficient coverage decision has resulted in further damage to the Insureds by preventing them from returning their property to its pre-loss condition, rather than participating in the settlement process in good faith. As a direct consequence of Homeowners Choice’s failure to adjust this loss in good faith and pay what is owed under the policy, the Insureds are continuing to sustain considerable hardship. Upon information and belief, Homeowners Choice, as part of its general business practice, initially lowballs its policyholders. Homeowners Choice does this in a calculated and systematic scheme that begins with manipulating the software system used in estimating its property damage claims. It appears that Homeowners Choice issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that Homeowners Choice trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that Homeowners Choice knows most policyholders generally would not know to request but are covered under the insureds policy. Moreover, as part of this scheme, after Homeowners Choice’s one initial low-ball payment – Homeowners Choice stalls and intentionally delays the claim, changing adjusters, all under the false pretense that it’s “investigating” the claim. Homeowners Choice has violated Florida Statute § 624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. Homeowners Choice has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this obviously covered claim to influence settlement in its favor. Despite being presented with all the indisputable evidence of the amount of damage sustained by this Property, it is disturbing that the Insureds have been treated in this manner by their insurance company after sustaining an obviously covered loss, submitting to every demand of Homeowners Choice, and Homeowners Choice failing to attempt to make a good faith effort to amicably come to a fair resolution. Homeowners Choice violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by Homeowners Choice making material misrepresentations to the Insureds for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. Homeowners Choice was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insureds. While Homeowners Choice was made aware of this information for the purpose of obtaining the money contractually owed to the Insureds under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, Homeowners Choice accepted that information and has used it to play the delay game with the Insureds, knowing all too well the additional damage and hardship that was being placed on the Insureds by its actions. Homeowners Choice violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation into this case. Homeowners Choice and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insureds. In addition, after being placed on notice as to the blatant underpayment of the Insureds claim, Homeowners Choice has yet to rectify their actions and do right by the Insureds by paying the money they are contractually owed. Homeowners Choice violated § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon the communications with respect to the claim. There has yet to be significant action taken by Homeowners Choice to this date, despite Homeowners Choice being presented with the flawed rationale behind their underpayment of the Insureds claim. Homeowners Choice violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insureds of any additional information necessary for processing the claim. The Insureds have more than complied with each and every request and there has still been no action by Homeowners Choice. In the event Homeowners Choice needs additional information, they have failed to promptly notify the Insureds in a timely manner. This pattern of behavior is perpetuated by Homeowners Choice and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insureds throughout the insurance claim process. Several duties and responsibilities to the Insureds were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from Homeowners Choice approaching the investigation and settlement in a manner prejudicial to the Insureds, failing to allow a fair settlement with the Insureds, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insureds were not afforded the professional duties entrusted to Homeowners Choice by the public. To date, Homeowners Choice has failed to adequately compensate the Insureds for the damage that occurred on March 16, 2022. As a direct result of Homeowners Choice’s delay, the Insureds were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that Homeowners Choice knowingly and intentionally is delaying the claims process to further disadvantage the Insureds. The financial detriment caused to the Insureds is a direct result of Homeowners Choice’s reckless delay in the claim process. The Insureds are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insureds timely filed their claim and fulfilled all their post-loss obligations. All requested information and documentation have been turned over to Homeowners Choice and their representatives promptly by the Insureds. However, Homeowners Choice failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insureds how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insureds the benefit of the bargain after they satisfied all their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Upon information and belief, the actions complained about, among others, were made by Homeowners Choice so often as to constitute a general business practice, evidencing a motive to enhance Homeowners Choice’s profits, and designed to cause a detrimental effect on its policy holders. Homeowners Choice was aware that the Insureds damages were covered and took advantage of their Insureds in an attempt to force them into an irreparably disadvantaged position, which they hope will force the Insureds to settle for less coverage than they are contractually entitled to under the policy. This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Homeowners Choice fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Homeowners Choice must: (1) Immediately tender all insurance proceeds due and owing to the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably place the Insureds back to a pre-loss condition ($96,571.00); (2) Agree to reimburse the Insureds reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be due and owing to the Insureds, relating back to the date of loss; (4) Although the Insureds have made a demand herein and has previously provided Homeowners Choice with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insureds are still willing to consider and to potentially accept any reasonable counter-offer made by Homeowners Choice. Therefore, if Homeowners Choice is not in agreement with the Insureds reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, the Insureds hereby request that Homeowners Choice now make a reasonable counteroffer before the expiration of the cure period.

Comments

User Id		Date Added		Comment
Legal@hcpci.com		04-23-2025		This is Homeowners Choice Property & Casualty Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by attorney Sapir Elazar on behalf of Lorraine and John Walsh (“Insured”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. HCPCI handled the claim in accordance with the policy and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Otherwise, the CRN is deficient. Generally, pursuant to Florida Statutes, Section 624.155, CRNs must identify and set forth statutory provisions insurers allegedly violated in handling insureds’ insurance claims along with specific, relevant insurance contract language and facts and circumstances. The foregoing provides insurers with notice of alleged statutory violations AND the opportunity to cure such alleged violations. Instead of complying with Florida Statutes, Section 624.155, the Insured’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; and relied on inaccurate and conclusory statements. The Insured’s laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, the Insured’s attorney filed a lawsuit based on the claim prior to the filing of this CRN. Regardless of the fact there were no violations in this case, any action by HCPCI to cure violations alleged in the CRN could have been used against HCPCI in the lawsuit. The foregoing shows abuse by the Insured and the Insured’s attorney of the CRN and legal processes. Also and generally, the CRN constitutes an abuse of the CRN process, contravenes the purpose of CRNs, which is to promote resolution of issues in insurance claims. The CRN must be rejected, and it cannot serve as the basis of any action against HCPCI. Upon request by the Florida Department of Financial Services, HCPCI will provide to the DFS detailed correspondence HCPCI provided regarding the claim.

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