Civil Remedy Notice of Insurer Violations
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Filing Number:     808252
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*   MUHAMMAD   First Name  
Policy # * 79-CH-P054-0 Claim #* 59-69G0-44V
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*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* KYLE STANFORTH, CLAIMS SPECIALIST - FLORIDA MATTERS TEAM, WITH ADJUSTER LICENSE W848051
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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.

The specific policy language in dispute includes the following provisions from State Farm Florida Insurance Company’s Homeowners Policy HW-2159: Section I – Losses Insured (Coverage A – Dwelling) “We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy.”? Section I – Losses Not Insured “We will not pay for any loss to the property described in Coverage A that consists of, or is directly and immediately caused by, one or more of the perils listed in items a. through m. below, regardless of whether the loss occurs abruptly or gradually, involves isolated or widespread damage, arises from natural or external forces, or occurs as a result of any combination of these:” Relevant exclusions cited by State Farm: g. Wear, tear, decay, marring, scratching, deterioration, inherent vice, latent defect, or mechanical breakdown h. Corrosion, electrolysis, or rust i. Wet or dry rot k. Settling, cracking, shrinking, bulging, or expansion of pavements, patios, foundations (including slabs, basement walls, crawl space walls, and footings), walls, floors, roofs, or ceilings? Section I – Conditions (Duties After Loss) “After a loss to which this insurance may apply, you must cooperate with us in the investigation of the claim and also see that the following duties are performed: a. Give immediate notice to us or our agent. e. Submit to us, within 60 days after the loss, your signed, sworn proof of loss.? Endorsement HO-2228.2 – Windstorm or Hurricane Claims Requirements “If hurricane or windstorm coverage is provided by this policy or by endorsement, give notice to us or our agent of any windstorm or hurricane loss, including, but not limited to, initial, supplemental and reopened claims, in accordance with policy requirements and within 3 years after the windstorm caused the covered damage.”? Dispute Overview State Farm argues that the damages claimed are the result of wear, tear, deterioration, and prior storm events, which are excluded under the policy. The insured disputes this position, arguing that the windstorm caused a peril-created opening that led to interior water intrusion, which should be covered. The insurer further denied the claim based on the insured’s failure to submit a sworn proof of loss within 60 days, despite accepting the SPOL form in substance but refusing it procedurally. This dispute revolves around whether the loss resulted from a covered windstorm event or was due to excluded causes such as wear and tear and whether State Farm wrongfully denied coverage by misapplying policy conditions.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Complainant: Jamil Muhammad 2557 Southwest 119th Way Miramar, FL 33025 Insured: Jamil Muhammad Insurer: State Farm Florida Insurance Company Claim Number: 59-69G0-44V Policy Number: 79-CH-P054-0 Facts and Circumstances Giving Rise to the Insurer's Violation: On June 12, 2024, the insured property located at 2557 Southwest 119th Way, Miramar, FL 33025, sustained damage due to a windstorm. The insured, Jamil Muhammad, promptly reported the loss and initiated a claim with State Farm Florida Insurance Company under policy number 79-CH-P054-0. Despite timely notification, State Farm failed to properly investigate the claim and, on November 14, 2024, issued a denial asserting that no wind or storm-related damage was found on the roof or the exterior of the property. State Farm further contended that the interior damage resulted from multiple storm events, thus refusing coverage. This determination was made without any reasonable or adequate investigation, contradicting evidence provided by the insured’s representatives, including Five Star Miami, Inc. Additionally, on October 16, 2024, the insured submitted a Sworn Statement in Proof of Loss (SPOL) totaling $117,078.84, which was acknowledged by State Farm on October 21, 2024. However, State Farm rejected the SPOL, citing untimely submission, despite the insured’s compliance with policy conditions. Following the unjust denial, the insured submitted a Notice of Intent to Litigate (NOIL) on December 4, 2024. State Farm responded on December 16, 2024, standing by its previous coverage determination without reconsideration or additional investigation. State Farm’s conduct in handling this claim demonstrates a clear pattern of bad faith as it: Statutory Violations State Farm Florida Insurance Company has violated the following provisions of Florida law: §624.155(1)(b)(1), Fla. Stat. - State Farm failed to attempt in good faith to settle the insured’s claim despite clear evidence that the loss was covered. The insurer had multiple opportunities to fairly resolve the claim, including when presented with the insured’s Sworn Proof of Loss and independent estimate. Instead of settling, State Farm issued a blanket denial without proper justification, forcing the insured into costly litigation. §624.155(1)(b)(3), Fla. Stat. - State Farm failed to promptly settle the insured’s claim despite clear evidence of a covered loss. The insurer's refusal to acknowledge storm-related damage and its piecemeal approach to rejecting portions of the claim show an attempt to leverage partial denials to influence the insured into accepting an unjust settlement. ¦626.9541(1)(i)(3)(a), Fla. Stat. - State Farm did not implement proper standards for investigating claims, as evidenced by its failure to conduct a thorough evaluation. The initial inspection was inadequate, failing to properly assess storm-created openings and subsequent water intrusion. Additionally, State Farm did not engage independent experts to fairly assess the loss before issuing its denial. ¦626.9541(1)(i)(3)(b), Fla. Stat. - State Farm misrepresented key policy provisions by stating that interior damages were not covered unless a storm-created opening was visibly present, despite Florida case law supporting coverage for wind-compromised roofs. The insurer selectively applied policy language to justify its denial while ignoring established industry standards for evaluating storm-related losses. ¦626.9541(1)(i)(3)(c), Fla. Stat. - State Farm failed to acknowledge and act promptly upon communications from the insured and his representatives. Repeated follow-ups regarding the claim status, requests for reconsideration, and documentation submissions were ignored or met with unjustified delays. ¦626.9541(1)(i)(3)(d), Fla. Stat. - State Farm denied the claim without conducting a reasonable investigation. The insurer ignored relevant meteorological data, expert evaluations, and damage assessments, instead relying on a brief inspection that failed to account for all possible sources of loss. ¦626.9541(1)(i)(3)(f), Fla. Stat. - State Farm failed to provide the insured with a clear, reasonable explanation for the denial. The November 14, 2024 coverage determination letter contained vague justifications and omitted key findings from the inspection, depriving the insured of necessary information to challenge the decision.Cure Demand: To cure these violations, State Farm must: Immediately rescind its denial and extend full coverage for the insured’s claim. Issue payment in the amount of $117,078.84 per the insured’s SPOL. Compensate the insured for additional costs incurred due to State Farm’s delay, including attorneys’ fees and related expenses. Conduct a proper investigation and adjust the claim in good faith pursuant to Florida law and policy provisions. Failure to cure these violations within sixty (60) days from the date of this notice will result in legal action against State Farm Florida Insurance Company for breach of contract and bad faith pursuant to Florida Statutes.
Comments
User Id Date Added Comment
admin@bernstein-chackman.com 04-01-2025 Dear Mr. Degennaro: This letter is to advise you that my firm represents State Farm Florida Insurance Company (hereinafter “State Farm”) in the matter referenced above. This shall serve as State Farm’s response to civil remedy notice number 808252, which was submitted to the Department of Financial Services on behalf of Jamil Muhammad, on February 25, 2025. The civil remedy notice states that State Farm violated §624.155 and §626.9541 by doing the following: not attempting in good faith to settle claims; failing to promptly settle claims; failing to adopt standards for proper claim investigation; and other alleged wrongdoings. State Farm denies all allegations of wrongdoing or violation of Florida Law. State Farm has acted in accordance with Florida law and the subject policy in its handling of this claim. Additionally, the civil remedy notice fails to comply with the requirements of Florida Statute §624.155. State Farm does not waive any deficiencies in the civil remedy notice with the filing of this response. The notice neglects to include facts which demonstrate that State Farm violated Florida law, fails to identify the specific policy language that was allegedly violated, or include a reasonable cure for the alleged violations. The purpose of the civil remedy notice is to grant the insurer an opportunity to cure the alleged violations of Florida law. Therefore, complainants must identify the specific policy provisions and statutory language that were violated. In addition, complainants must identify what actions the insurer did that violated such provisions and identify what actions must be taken to cure the violations. As such, Florida Statute §624.155(3)(b) states: The notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: 1. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. 2. The facts and circumstances giving rise to the violation. 3. The name of any individual involved in the violation. 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In this instance, civil remedy notice 808252 does not include specific facts and circumstances that demonstrate a violation as required by §624.155(3)(b)(2). The notice contains conclusory allegations that State Farm improperly and insufficiently adjusted the claim. As such, the notice fails to comply with §624.155(3)(b)(4). See Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000) & Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The Insured procured policy number 79-CH-P054-0 for the property located at 2557 SW 119th Way, Miramar, FL., 33025. This claim was reported on June 13, 2024, by the insured. He stated during the quality first contact that heavy rain caused water to leak through the ceiling. The insured does not know what caused water to come into the house. The Insured submitted an estimate prepared by his public adjuster totaling $117,078.84. The estimate includes costs to replace the roof ($61,203.22) of the property. The property was inspected by Gina Rodriguez on November 1, 2024. The insured stated that when him and Gina spoke on June 20, 2024, he had a small stain on bathroom ceiling (he had not mentioned that before). He also stated that the stain grew and another stain appeared on the kitchen ceiling and got progressively worse until water started coming down behind the tile wall in bathtub into the bathtub & then from AC vent & a light in kitchen & then a stain appeared next to wall above upper cabinets. The insured stated that if it rained hard enough, the water would come down. After that, the insured would just dry off the floors. The roof was installed in 2014 and the insured lived in the property for five years. Furthermore, the insured paid $3,750 to Fl Quality Roofing for a roof repair on August 26, 2024. The receipt said "Repair 1 leak over valley on 3 story building". Hancock inspected the roof on the same day that Gina inspected. No wind nor hail damage was found. Prior repairs were found to the back slope. The Hancock report noted the following: "Roof structure...in worn but functional condition. Manufactured damage in the form of foot falls. Valley on back slope appears to have been previously repaired. Tiles on 2nd story front slope are not secured properly" The claim was initially withdrawn. After that and State Farm’s investigation, the claim was denied by letter dated November 14, 2024: The Insured filed a Notice of Intent with the Department on December 4, 2024. State Farm responded to the notice standing by the denial. The Insured filed suit on December 18, 2024, for one count breach of contract. At this time, nothing has been presented to State Farm that would change its coverage determination. In this Civil Remedy Notice the claimant alleges that State Farm violated §624.155(1)(b)(1) and §624.155(1)(b)(3) by 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 his interests and failing to promptly settle claims. However, this claim was properly denied. There is no coverage under this policy for the claim made. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon communications. In this claim, State Farm timely acknowledged the claim and acted promptly after the reporting of the claim. The claim was then properly denied. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of the claim. In this claim, based on State Farm’s inspection and evaluation of the claim, it was determined that there was no coverage for the damage being claimed. There was no wind damage to the property. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations. However, State Farm did conduct a reasonable investigation. Gina Rodriguez and Hancock Claims performed in-person inspections and then reviewed all of the documents submitted. Based on that it was determined that there is no coverage under the policy for this claim. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(f) by 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 and §626.9541(1)(i)(3)(g) by failing to promptly notify the insured of any additional information necessary for the processing of a claim. In this case, no additional information was necessary. State Farm also provided a detailed claim determination letter, which set forth the facts and policy provisions as to why there is no coverage under the policy for this claim. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(b); §626.9541(1)(i)(3)(e) and §626.9541(1)(i)(3)(h) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; 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 and failing to clearly explain the nature of the requested information and the reasons why such information is necessary. However, State Farm did not misrepresent any facts. A detailed claim determination letter was sent outlining the reasons and policy provisions for the denial of the claim. No information was requested either. State Farm denies all allegations of non-compliance with Florida law or the subject policy. Furthermore, the civil remedy notice is deficient in that it does not comply with the requirements of Florida Statute §624.155(3)(b). State Farm does not waive any such deficiencies in the filing of this response. Regardless, the accusations raised within the notice are devoid of merit. Thank you for your attention to the above. Very truly yours, /s/ Brian A. Chackman Brian A. Chackman
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