Civil Remedy Notice of Insurer Violations
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Filing Number:     808235
Filing Accepted:  2/25/2025
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Complainant
Last/Business Name *  
DEGENNARO   First Name   BRITT
Street Address * 800 E BROWARD BLVD, SUITE 501
City, State Zip * FT LAUDERDALE, FL 33301
Email Address * BD@WEKLAW.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   HARDEN   First Name  
Policy # * 0762028306 Claim #* 7007042501-1
Attorney
Attorney is Applicable
Last Name* DEGENNARO First Name * BRITT Initial
Street Address* 800 E BROWARD BLVD, SUITE 501
City, State Zip* FT LAUDERDALE , FL 33301
Email Address * BD@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* MIKE SARVER AND MATT MILLWARD
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Coverage Provision Payment Provision The specific policy language in dispute in the Harden claim includes provisions under Section I - Perils Insured Against of the Farmers Florida Homeowners Policy, 1st Edition, as endorsed. The key contested provisions include: Coverage A - Dwelling and Coverage B - Other Structures: The policy states that it insures against accidental direct physical loss or damage to the property described in Coverages A and B unless the loss is excluded under Section I - Exclusions. Exclusions under Section I - Perils Insured Against: (f) Any of the following are excluded: (i) Wear and tear, deterioration. (ii) Decay. (iii) Marring. (iv) Mechanical breakdown, latent defect, inherent vice, or any quality in property that causes it to damage or destroy itself. (vii) Discharge, dispersal, seepage, migration, release, or escape of "pollutants" unless the discharge, dispersal, seepage, migration, release, or escape is itself caused by a Peril Insured Against named under Coverage C. (viii) Settling, shrinking, bulging, movement, cracking, heaving, bending, or expansion of any part of insured property. (xii) Accidental discharge or overflow of water or steam, unless loss to property covered under Coverage A or B results from an accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning, or automatic fire protective sprinkler system or household appliance on the "residence premises." Constant or Repeating Gradual or Slow Release, Seepage or Leakage of Water: The policy excludes coverage for any constant or repeating gradual or slow release, seepage, or leakage of water or the presence of water, condensation, humidity, moisture, or vapor over weeks, months, or years, regardless of the volume of water involved. The insurer used these provisions to deny coverage for the interior water damage, asserting that the cause was long-term humidity and condensation, which the policy does not cover. However, the insureds argue that the roof damage from the windstorm event created an opening that allowed water to enter the home, making the interior damages a direct result of the covered peril. This dispute forms the basis of the bad faith claim against Farmers/Truck Insurance Exchange?
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Complainant: Leonard Harden & Gaynell Harden 15823 Lexington Park BlvdJacksonville, FL 32218 Insurer: Farmers Insurance (Truck Insurance Exchange) Claim Number: 7007042501-1 Policy Number: 0762028306 Date of Loss: January 9, 2024 Notice Accepted: October 25, 2024 Factual Summary On January 9, 2024, the insureds, Leonard and Gaynell Harden, suffered damage to their property located at 15823 Lexington Park Blvd, Jacksonville, FL 32218, due to a windstorm event. The insureds promptly reported the loss to Farmers Insurance (Truck Insurance Exchange) under policy number 0762028306. The claim, identified as Claim Number 7007042501-1, included damage to the roof and interior areas of the home, particularly the master bedroom, second-floor hall and stairs, garage, and ceiling fixtures. Farmers conducted an initial inspection and determined that only 11 shingles were affected by wind damage, asserting that the impact was minor and repairable rather than necessitating a full roof replacement. Furthermore, the insurer denied coverage for interior damages, citing long-term humidity and condensation as the cause rather than storm-related water intrusion. The denial ignored the fact that wind damage had compromised the integrity of the roof, leading to interior water infiltration. Seeking a fair assessment, the insureds retained Eco Restore, LLC, a licensed contractor, to conduct an independent evaluation. Their report estimated the necessary repair costs at $54,378.48 for roof replacement and $9,985.13 for interior damages, far exceeding the insurer’s assessment. Despite this, Farmers refused to reconsider its denial and failed to provide a proper explanation for rejecting the interior damages. As a result, the insureds engaged legal representation from Weisser, Elazar & Kantor, PLLC, who submitted a supplemental payment request, followed by a Notice of Intent to Initiate Litigation (NOITL) on October 25, 2024. The presuit settlement demand was $73,717.00, comprising $68,717.00 in damages and $5,000.00 in attorney’s fees. Farmers continued to deny coverage, forcing the insureds into litigation rather than fairly adjusting the claim. Farmers’ bad-faith handling of the claim was evident through its deliberate underpayment and wrongful denial of interior damages, its failure to fully evaluate the extent of wind damage, and its misrepresentation of policy provisions to limit indemnification. The insurer’s failure to recognize roof damage as a proximate cause of interior water intrusion and its refusal to properly engage in settlement discussions demonstrate a clear violation of its statutory and contractual obligations. Statutory Provisions Violated Farmers failed to properly assess the full extent of damages in the Harden claim, choosing instead to apply an arbitrary threshold for roof repair and ignoring clear evidence of interior water damage caused by the storm. The insurer refused to reconsider its decision despite additional documentation from a licensed contractor (Eco Restore, LLC) and the insured’s legal counsel. By failing to engage in meaningful negotiations or settlement discussions, Farmers demonstrated a lack of good faith in handling the claim. Farmers acknowledged limited wind damage to the roof but refused to issue full payment for necessary repairs. Instead, it denied interior damages outright, despite clear evidence of water intrusion through storm-compromised areas. This delay and piecemeal adjustment were intended to pressure the insureds into accepting an unjust settlement, leveraging the partial approval of the roof claim to manipulate negotiations regarding the interior damages. Farmers misrepresented the extent of the damage by asserting that only 11 shingles were affected by wind and that the interior damages were due to long-term humidity and condensation, not storm damage. This misrepresentation disregarded both expert evaluations and the conditions observed at the time of loss, leading to an unfair settlement offer significantly below the actual cost of necessary repairs. Farmers' inspection was cursory and insufficient, failing to properly evaluate the full extent of damages caused by wind and water intrusion. The insurer did not retain an independent expert to assess the interior damages, nor did it apply standard industry practices for evaluating whether a full roof replacement was necessary. The lack of a standardized claims-handling protocol resulted in an improper denial and an underestimation of the insureds' losses. Farmers misrepresented policy terms by claiming that interior water intrusion was only covered if a “storm-created opening” was present, despite the fact that wind damage to the roof constitutes an opening under Florida case law. The insurer selectively applied policy provisions to justify its denial, rather than conducting a fair and objective evaluation of the claim. Farmers failed to acknowledge and act promptly upon communications regarding the claim, leading to unnecessary delays in the claims-handling process and depriving the insureds of timely resolution. Farmers denied the claim without conducting a reasonable investigation, failing to properly analyze how wind damage compromised the roof and resulted in interior water intrusion. This lack of a thorough evaluation directly violated industry standards and Florida statutory requirements. The insurer failed to provide a prompt and reasonable written explanation for its denial, leaving the insureds without adequate information regarding the basis of its decision. Instead of offering a fair settlement, Farmers sought to minimize its financial exposure by disregarding key evidence that supported full coverage for the claim. 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. Farmers failed to properly assess the full extent of damages in the Harden claim, choosing instead to apply an arbitrary threshold for roof repair and ignoring clear evidence of interior water damage caused by the storm. The insurer refused to reconsider its decision despite additional documentation from a licensed contractor (Eco Restore, LLC) and the insured’s legal counsel. By failing to engage in meaningful negotiations or settlement discussions, Farmers demonstrated a lack of good faith in handling the claim. 624.155(1)(b)(3): 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. Farmers acknowledged limited wind damage to the roof but refused to issue full payment for necessary repairs. Instead, it denied interior damages outright, despite clear evidence of water intrusion through storm-compromised areas. This delay and piecemeal adjustment were intended to pressure the insureds into accepting an unjust settlement, leveraging the partial approval of the roof claim to manipulate negotiations regarding the interior damages. 626.9541(1)(i)(2): A material misrepresentation made to an insured for the purpose of settling a claim on less favorable terms than those provided in the policy. Farmers misrepresented the extent of the damage by asserting that only 11 shingles were affected by wind and that the interior damages were due to long-term humidity and condensation, not storm damage. This misrepresentation disregarded both expert evaluations and the conditions observed at the time of loss, leading to an unfair settlement offer significantly below the actual cost of necessary repairs. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Farmers' inspection was cursory and insufficient, failing to properly evaluate the full extent of damages caused by wind and water intrusion. The insurer did not retain an independent expert to assess the interior damages, nor did it apply standard industry practices for evaluating whether a full roof replacement was necessary. The lack of a standardized claims-handling protocol resulted in an improper denial and an underestimation of the insureds' losses. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverage at issue. Farmers misrepresented policy terms by claiming that interior water intrusion was only covered if a “storm-created opening” was present, despite the fact that wind damage to the roof constitutes an opening under Florida case law. The insurer selectively applied policy provisions to justify its denial, rather than conducting a fair and objective evaluation of the claim. Cure Demand To cure these violations and restore the insureds to their pre-loss condition, Farmers must: Issue full payment for the roof replacement and interior damages in the amount of $64,363.61 plus applicable interest. Reimburse attorney fees and costs incurred due to Farmers’ bad faith conduct. Cease and desist from misrepresenting policy coverage and establish fair and transparent claims-handling guidelines. Provide a written explanation of how future claims will be handled differently to ensure proper application of Florida law and insurance standards. Failure to cure these violations within sixty (60) days from the date of this notice will result in the insureds proceeding with legal action, including but not limited to a claim for bad faith damages under Florida Statutes §624.155. Farmers’ ongoing refusal to handle this claim fairly and in accordance with Florida law exposes them to significant liability, including punitive damages. This notice serves as a final opportunity for Farmers to rectify its improper handling of this claim and fulfill its contractual and statutory obligations to the insureds.
Comments
User Id Date Added Comment
bhenry@smithrolfes.com 03-10-2025 This is Truck Insurance Exchange’s response to Civil Remedy Notice Number 808235, which was filed on behalf of Gaynell Harden and Leonard Harden (“Insureds”) on February 25, 2025. The subject homeowner’s policy was issued to the Insureds by Truck Insurance Exchange, NAIC 21709, whose mailing address is 6301 Owensmouth Avenue, Woodland Hills, California. After reviewing the Civil Remedy Notice, Truck Insurance Exchange, through its agents, conducted a thorough review of the handling of the Insureds’ claim. Truck Insurance Exchange denies that it violated any statutes, administrative code provisions, or ethical rules or obligations in connection with its investigation and handling of the Insureds’ claim. At all times, Truck Insurance Exchange acted in good faith, fairly, and honestly towards the Insureds, with due regard for the interests of the Insureds. Truck Insurance Exchange denies each and every alleged violation set forth in the Civil Remedy Notice. An insurance claim was reported by the Insureds on January 16, 2024, pursuant to their homeowners’ policy, for alleged wind damage to the roof and interior water and mold damage to the property located at 15823 Lexington Park Boulevard, Jacksonville, Florida, with an alleged date of loss of January 9, 2024. Mr. Matthew Millward (“Mr. Millward”) was assigned as the Claims Representative for the processing of the Insureds’ claim. After receiving notice of the loss on January 16, 2024, Mr. Millward coordinated an inspection of the property to occur on January 21, 2024. On January 21, 2024, Mr. Millward conducted an inspection of the property, accompanied by the Insureds and a roofing salesman from Beaver Roofing. During his exterior assessment, Mr. Millward observed eleven (11) shingles with direct windstorm-related damage. However, these affected shingles constituted less than 1% of the total roof area and were deemed repairable under the Florida Building Codes. Additionally, he identified signs of aging, such as blistering and nail pops, which are specifically excluded under the policy. Regarding the home’s interior, Mr. Millward determined that the mold visible through light fixtures and smoke alarms on the second-floor ceiling was caused by humidity and chronic condensation buildup over at least thirty (30) days due to attic air infiltration. He also found that the garage water damage resulted from continuous wind-driven rain over an extended period, evidenced by wood rot in the roof deck during the attic inspection. As for the master bedroom, Mr. Millward found no actual water damage, only deterioration of the caulking. Following the inspection, Mr. Millward decided to consult an expert to further assess the mold issue. On January 25, 2024, AirSpec, a mold assessment company retained by Mr. Millward, inspected the property. Their findings confirmed that mold infiltrating the smoke alarm and light fixture stemmed from chronic condensation due to attic air infiltration, while mold in the garage ceiling resulted from a persistent roof leak leading to sporadic water intrusion. On February 7, 2024, Mr. Millward issued a Claim Outcome Letter to the Insureds informing them of the coverage decision based on Truck Insurance Exchange’s investigation of the subject claim. The letter went on to inform the Insured of the following: In order for payment to be issued for the damages, the amount of the loss must exceed the amount of your deductible. Since the amount of estimated damages is less than your deductible, no payments can be issued at this time and we are closing our claim file. This determination was based on the estimate you submitted for our review or one we created on your behalf. If we prepared the estimate, it has been included with this correspondence. We suggest you provide a copy of this estimate to your contractor in order to determine if they can complete the covered repairs for the gross replacement cost amount. If the contractor you choose to make the repairs is going to charge more than the amount shown on the estimate, it is important that you or the contractor call us before the work begins so that we will have an opportunity to re-evaluate the damage and review the contractor's recommendations. You reported windstorm damage to your roof and interior water damage and mold to your interior ceilings in several rooms. My investigation involved completing a thorough roof inspection and hiring a water and mold mitigation expert to evaluate the causation and origin of the mold your reported. My roof inspection revealed 11 shingles on your roof that were directly and physically damaged by a windstorm. This represents less than 1% of the total surface area of your roof and based on Florida building code is repairable. I also found signs of blistering and nail pops from age related deterioration over time on several other shingles of your roof. Your policy does not cover age related deterioration or wear and tear. The water and mold cause and origin analysis revealed that the mold coming through the light fixtures and smoke alarms in the 2nd floor ceiling is due to the presence of humidity and chronic condensation collecting for at least over 30 days from attic air infiltration. Your policy does not cover the presence of humidity and condensation that has been occurring for weeks, months, or years. The water damage in your garage is due to continuous wind driven rain over a period of at least 30 days. This was determined due to the wood rot showing in the roof decking during the attic inspection. Your policy does not cover continuous leakage occurring for weeks, months, or years. The water damaged claimed in your master bedroom is not water damage but deterioration of caulking. This is unrelated to the cause of loss of windstorm and not covered under this claim. Unfortunately, there is no coverage for the interior portion of your claim based on the facts known to us at the present time. We encourage you to review the terms of your Farmers Florida Homeowners Policy, 1st Ed, as endorsed. They form the basis for our decision. We have attached a “Coverage Outcome – Policy Provisions” document that refers you to the applicable sections of the policy. We’ve completed the adjustment of your loss and we are closing your claim. Closing your claim does not affect processing payments for recoverable depreciation, or outstanding payment for any other covered part of the claim that has already been accepted and adjusted. Closing your claim does not prevent you from providing us with additional information, including supplemental claims and requests for recoverable depreciation, within the time limits stated in your policy. We will inform you in writing if any such additional information results in reopening your claim. Section I - Perils Insured Against A. Coverage A - Dwelling and Coverage B - Other Structures 1. We insure against accidental direct physical loss or damage to the property described in Coverages A and B, unless the loss is excluded in Section - I Exclusions 2. We do not insure, however, for loss or damage: a. Excluded under Section I - Exclusions; (f) Any of the following: (i) Wear and tear, deterioration; (ii) Decay; (iii) Marring; (iv) Mechanical breakdown, latent defect, inherent vice or any quality in property that causes it to damage or destroy itself; (vii) Discharge, dispersal, seepage, migration, release or escape of "pollutants" unless the discharge, dispersal, seepage, migration, release or escape is itself caused by a Peril Insured Against named under Coverage C. (viii) Settling, shrinking, bulging, movement, cracking, heaving, bending or expansion of any part of insured property, including but not limited to bulkheads, pavements, patios, footings, supports, foundations, foundation fill material, foundation piers, foundation beams, slabs, pads, walls, floors, roofs, roof structures, ceilings, driveways, walks, curbs, fences, retaining walls, spas or swimming pools; (xii) Accidental discharge or overflow of water or steam, unless loss to property covered under Coverage A or B results from an accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance on the "residence premises". Loss to property covered under Coverage A or B that results from an accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance on the "residence premises" includes the cost to tear out and repair only that part of a building or only that part of an other structure covered under Coverage A or B, on the "residence premises", necessary to access the system or appliance. The cost that we will pay for the tear out and repair of the part or portion of the building or other structure covered under Coverage A or B as specified above is limited to only that part or portion of the covered building or other structure which is necessary to provide access to the part or portion of the system or appliance that caused the covered loss, whether the system or appliance, or any part or portion of the system or appliance, is repairable or not. Section I – Exclusions A. We do not insure, under any coverage, for loss or damage which directly or indirectly is caused by arises out of, or results from any of the following excluded causes of loss or damage, whether the loss or damage occurs in or on or away from the "residence premises", or for any loss or damage which would not have occurred in the absence of one or more of the following excluded events We do not insure for such loss or damage regardless of: a. The cause of the excluded event; b. Other causes of the loss or damage; c. Whether other causes acted concurrently or in any combination or sequence with the excluded event to produce the loss or damage; or d. Whether the event occurs abruptly and suddenly or gradually, or involves isolated or widespread damage, or arises from natural or external forces, or occurs as a result of any combination of these 12. Constant or Repeating Gradual or Slow Release, Seepage or Leakage of Water A constant or repeating gradual or slow release, seepage or leakage of water or the presence of water, condensation or humidity, moisture or vapor, over a period of weeks, months or years, regardless of the volume of water involved. We do not cover the presence of any form of water over a period of weeks, months or years, from any constant or repeating gradual or slow seepage, leakage, trickle, collection, spray or mist, or the infiltration or overflow of water from any source. On October 28, 2024, Truck Insurance Exchange received a Notice of Intent to Initiate Litigation (“NOI”) from the Insureds’ attorney, along with an attached estimate as supporting documentation, for a pre-suit demand of $73,717.00. On October 29, 2024, Mr. Michael Sarver, Claims Adjuster, responded to the NOI by extending a pre-suit settlement offer of $29,300.00 in exchange for a release of all claims; this pre-suit settlement offer was not accepted. Insureds’ Civil Remedy Notice accuses Truck Insurance Exchange of violating a laundry list of every remotely applicable statute. Truck Insurance Exchange denies each and every one of these allegations and denies that it violated any statute. Truck Insurance Exchange properly investigated the claim and came to the conclusion that not all the reported damage was covered under the subject policy. Insureds’ Civil Remedy Notice further suffers from a fundamental deficiency. Florida Statute § 624.155(3) requires that a Notice filed with the Department must include specific policy language that is relevant to the violation. Insureds have not provided the specific policy language that is relevant to its Civil Remedy Notice. Rather, Insureds reference a general provision of the policy without pointing to specific language relevant to their allegations. The Notice, therefore, fails to meet the elements of the statute and should be dismissed. Finally, with respect to the methods of curing the purported violations set forth in the Civil Remedy Notice, Truck Insurance Exchange has properly, thoroughly, and promptly investigated the Insureds’ claims. Truck Insurance Exchange disputes that it owes any payment to the Insured as Truck Insurance Exchange has previously issued a claim outcome letter informing Insureds that not all the alleged damages associated with the reported loss are covered under the policy. Truck Insurance Exchange has acted fairly and honestly toward its Insureds with due regard for their interest in resolving the claim. With respect to the demand that Truck Insurance Exchange tender payment to the Insureds, that request is respectfully denied. Based on the foregoing, Truck Insurance Exchange maintains it has not violated any of the statutes identified in the Civil Remedy Notice, or any other statute. Truck Insurance Exchange promptly and properly investigated Insureds’ claim and has determined the full extent of damage covered by the insurance policy. Truck Insurance Exchange does not waive or intend to waive any rights or remedies that it may have with respect to Insureds’ claim. Truck Insurance Exchange specifically reserves all rights and defenses under the subject policy and under Florida law. Truck Insurance Exchange does not waive any of the terms, conditions, limitations, or exclusions of the policy.
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