Civil Remedy Notice of Insurer Violations
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Filing Number:     808303
Filing Accepted:  2/25/2025
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Complainant
Last/Business Name *  
MAXIM VAYNTRAUB AND JANE VAYNTRAUB   First Name  
Street Address * 2707 SOUTH PARKVIEW DRIVE
City, State Zip * HALLANDALE BEACH, FL 33009
Email Address * MAX@ISAPROSPORTS.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MAXIM VAYNTRAUB AND JANE VAYNTRAUB   First Name  
Policy # * RNR3378948 Claim #* 966702
Attorney
Attorney is Applicable
Last Name* FOSKY First Name * JORDON Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JFOSKY@KPATTORNEY.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):* MAURICE HAZEN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Unsatisfactory Settlement Offer
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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)(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.
* 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 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.

The carrier was put on notice of the insureds’ water damage claim. The carrier initially attempted to low-ball the claim. Subsequently, the insureds prepared a loss package in the amount of $219,186.98 needed to restore the property back to its pre-loss condition. This was provided ot the carrier. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $13,693.94 only, leaving a remainder in the amount of $205,493.04 to be paid in order to cure the breach, less any applicable policy deductible. The insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About two hundred sixty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insureds’ property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $219,186.98, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Devin Pruitt at (239) 488-6829 if you have any questions or concerns. Sincerely, Jordon Fosky Attorney at Law
Comments
User Id Date Added Comment
klyde.bedford@csklegal.com 04-24-2025 Dear Mr. Fosky: This correspondence is in response to the Civil Remedy Notice of Insurer Violations (hereinafter referred to as the “Notice”) filed by Jordon Fosky, Esq., on behalf of Maxim Vayntraub (hereinafter referred to as “Insured” or “Claimant”). The Department of Financial Services assigned an accepted date of February 25, 2025, for the Notice. As you are aware, the law firm Cole, Scott & Kissane, P.A. has been retained to represent Certain Underwriters at Lloyd’s, London (hereinafter referred to as “Insurer” or “Underwriters”) in this matter. This matter concerns a claim regarding alleged water damage pursuant to a homeowners’ insurance policy provided by Policy No.: RNR3378948. Underwriters welcome this opportunity to respond to the Notice and deny each and every allegation contained therein. Underwriters do not consider there to have been any manner of violation and questions the validity of the Notice as it fails to meet the requirements set forth in Florida Statute Section 624.155 and Florida law and thus fails to perfect the Claimant’ right to pursue civil remedies under Florida Statutes. Furthermore, the Notice does not accurately reflect the development of the claim as presented. The potential statutory violations and facts provided are nothing more than unsupported, baseless allegations. There are no facts or circumstances to support any kind of mishandling of this matter by Underwriters. As indicated below, the subject property was dutifully inspected and proper coverage for the claim was afforded based on the clear meaning of the subject policy. I. Specificity Requirement The Claimant’s Civil Remedy Notice violates multiple requirements set forth in the Florida courts’ jurisprudence for civil remedy notices. In addition, it fails to meet even the most basic requirements of the Statute. Accordingly, Underwriters respectfully requests the Department return the Civil Remedy Notice and insist the Claimant provide the specific facts required for civil remedy notices. See Section 624.155(3)(c), Fla. Stat. (2021). These requirements arise from the following provisions of Section 624.155(3)(c): (3)(a) As a condition precedent to bringing an action under this section, the department and the authorized insurer must have been given 60 days' written notice of the violation. If the department returns a notice for lack of specificity, the 60-day time period shall not begin until a proper notice is filed. (b) 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 (emphasis added): 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, he 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 interpreting this statute, courts have emphasized the importance of filing specific civil remedy notices. The civil remedy notice is “crucial to the procedural integrity of an action” under the Statute. Allstate Ins. Co. v. Clohessy, 32 F. Supp. 2d 1328, 1333 (M.D. Fla. 1998). “It is, without a doubt, a condition that must be satisfied in order for one to perfect the right to sue under the statute.” Id. “In creating this statutory remedy for bad-faith actions, the Legislature provided this sixty-day window as a last opportunity for insurers to comply with their claim-handling obligations when a good-faith decision by the insurer would indicate that contractual benefits are owed.” Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1284 (Fla. 2000). Thus, the Notice cannot be “vague and ‘shotgun’ in nature,” rather than “the type of specific notice required by the statute that would allow [the insurer] an opportunity to cure.” Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299 (S.D. Fla. 2008). Because it is in derogation of the common law, Section 624.155(1)(b), Florida Statutes must be strictly construed. Talat, 753 So. 2d at 1283 (citing Baxter v. Royal Indem. Co., 285 So. 2d 652 (Fla. 1st DCA 1973)). To perfect the right to sue under the statute, the insured must specifically notify the insured of any and all alleged violations claimed. Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773, 776 (M.D. Fla. 1996) (“Talat I”). In Valenti, the District Court for the Middle District of Florida considered the practical consequences of an insured’s non-specific civil remedy notice. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The plaintiffs’ civil remedy notice included allegations that the defendant conducted an inadequate investigation. The plaintiffs, however, failed to identify with the requisite specificity the defendant’s actions that were inadequate. The Middle District held that the plaintiff’s civil remedy notice was insufficient, and stated the following: [T]he civil remedy notice must be specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days. … Plaintiffs’ counsel, during the hearing in this matter, argued a civil remedy notice that states “you denied my claim” should be sufficient to place the insurer on notice of what was needed to be cured. Plaintiffs’ counsel further argued that it was up to the insurer, as the insurance expert, to decipher what actions needed to be cured. This argument, in this Court's estimation, is illogical and is counter to the purpose of the civil remedy notice. If a simple “you denied my claim” was sufficient to put insurers on notice, the sixty-day cure period would be little more than a guessing game with the insurer attempting to correctly guess what errors the insured claimed it made in the claims handling process, or risk defending a bad faith action. This surely is not what the legislature had in mind when it created the civil remedy notice. Accordingly, this Court finds that Plaintiffs allegation that Defendant failed to conduct an adequate investigation is insufficient to provide Defendant an opportunity to cure. Id. at *2. The guidance for an insured could not be clearer. “The purpose of the civil remedy notice is to give the insurer one last chance to settle a claim with its insured and avoid unnecessary bad faith litigation.” Lane v. Westfield Insurance Co., 862 So. 2d 774, 779 (Fla. 5th DCA 2004). Its purpose is not “to give the insured a right of action to proceed against the insurer even after the insured’s claim has been paid or resolved.” Id. Ultimately, conclusory allegations without facts fail to perfect a statutory bad faith claim. Merely alleging the bare minimum allegations is insufficient pursuant to Florida courts’ interpretations of Section 624.155, Florida Statutes. II. The Elements of a Valid Civil Remedy Notice There are at least eight requirements for a valid civil remedy notice. Pursuant to Section 624.155(3)(c)’s requirement that a civil remedy notice must set forth the “facts and circumstances giving rise to the violation,” a valid civil remedy notice must contain the following: 1. “explain how the [insurer] violated [the statutes],” Heritage Corp., 580 F.Supp. 2d at 1299; 2. “explain the amounts of damage at issue caused by the [insurer’s] alleged statutory violations,” rather than caused by the loss itself, Id.; 3. Provide the facts showing “knowledge and/or delay on the insurance company’s part,” 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1192 (N.D. Fla. 2008). 4. provide the facts supporting the specific contractual damages allegedly owed rather than merely the policy limits, Id. at 1193; 5. if an inadequate investigation is alleged, the civil remedy notice must be specific enough to allow the insurer to conduct an additional investigation, Nowak v. Lexington Ins. Co., 464 F.Supp.2d 1248, 1252 (S.D. Fla. 2006). Additionally, subsections (3)(a)1., 3. and 4. require: 6. “the statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated;” 7. “the name of any individual involved in the violation;” and 8. “Reference to specific policy language that is relevant to the violation.” As noted, the first five requirements mandate the insured to provide specific facts and circumstances of the alleged violations. This would necessarily include specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti, 2006 WL 1627276, at *1. Florida law does not allow an insured, without providing any facts, to allege that the insurer’s only option to avoid bad faith is paying whatever the insured demands. 316, Inc., 625 F.Supp.2d at 1194. Requirements two and four regarding the alleged damages must also be specifically provided in the civil remedy notices. Importantly, the Talat court held that payment of undisputed damages within the cure period is sufficient to preclude a statutory bad faith action. In that circumstance, the insurer has “timely paid ‘the damages’ and has corrected ‘the circumstances giving rise to the violation’ within the meaning of [Section 624.155(2)(d), Florida Statutes].” Id. at 1281. The insurer is not required to pay any compensatory damages that flow from any alleged delay in settling the claim. Importantly, only the contractual benefits are owed during the 60-day cure period. To provide an insurer with the notice of the contractual and extra-contractual damages, Florida law clearly requires facts supporting the amount. Merely requesting payment within policy limits without any basis renders the civil remedy notice invalid. If the civil remedy notice does not satisfy each of the eight elements, it cannot be considered valid pursuant to the Florida case authority cited above. A further requirement of section 624.155, Florida Statutes, is that the complainant shall state with specificity the name of any individual involved in the violation. § 624.155(3)(b)3, Fla. Stat. The Claimant does not name a single individual; therefore, this Notice does not meet the requirements of the statute. For these reasons alone, this CRN should be stricken as the Notice clearly suffers from lack of specificity pursuant to section 624.155(3)(c), Florida Statutes (“Within 20 days of receipt of the notice, the department may return any notice that does not provide the specific information required by this section, and the department shall indicate the specific deficiencies contained in the notice.”). III. Facts The irrefutable facts surrounding this claim are as follows. The claim was reported by Best Public Adjusters (“Public Adjuster”) on or about June 20, 2024. It was reported that the Insured property sustained flood damage on or about June 12, 2024. On June 21, 2024, Underwriters’ assigned adjuster inspected the subject property. On August 16, 2024, Underwriters issued payment to the insured as well as their mitigation company, LG Remediation of Florida. Shortly thereafter, the Public Adjuster submitted a disputing estimate. At that point, Underwriters determined a subsequent inspection of the property was warranted due to the vast discrepancy between the adjusters’ estimates. On September 19, 2024, Fernando Martinez of Forensic Consultants of North America, Underwriters’ enlisted engineer, inspects the subject property. On September 25, 2024, Underwriters sent a reservation of rights letter. On October 1, 2024, the Public Adjuster sent an executed sworn proof of loss with a net claim of $219,186, based on the disputing estimate. On October 9, 2024, Underwriters sent a letter rejecting the estimate and sworn proof of loss based on a disagreement in scope. On November 18, 2024, following receipt of the engineer’s report and the completion of a thorough inspection, Underwriters sent a partial denial letter to the insured based on the findings therein. The letter clearly outlined the findings of the investigation and the portions of the subject policy that applied to the coverage decision, both portions that were determined to be covered and excluded. On February 16, 2025, your office sent its letter of representation. On February 25, 2025, your office filed this Notice. On March 11, 2025, your office filed a Notice of Intent to Initiate Litigation bearing notice number 234833. On March 25, 2025, our office responded to the Notice of Intent by invoking Underwriters’ right to a pre-suit mediation under Fla. Stat. 627.70152. To date, we have not heard a response from your office regarding setting the mediation, though Underwriters will be sure to abide by its statutory duty to complete the pre-suit mediation within 90 days of its response sent on March 25, 2025. IV. Inaccuracy of Statutory Allegations in Civil Remedy Notice With the above referenced facts established, it is clear the alleged statutory violations are also unsupported. Without any supporting facts other than conclusory statements provided by Claimants, Underwriters cannot adequately address the same. In our factual analysis provided in this Response, we provided facts that implicitly address many of the allegations in the Notice. From those facts, it becomes clear that Underwriters is dealing with the claim pursuant to the professional standards of care. Your notice alleges the following statutory violations by Underwriters and, because of the bare nature of the allegations and facts provided, we address each as follows: • Not attempting in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regards for her or his interests – This allegation is not supported by the facts. Nothing has indicated Underwriters “should” have settled this matter. Rather, the investigation thus far has revealed that Underwriters have issued all payments due pursuant to the coverages available under the subject policy. • 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 – This allegation is not supported by the facts. The “obligation to settle” has never become “reasonably clear” as this allegation suggests. Rather, the investigation thus far has revealed that Underwriters have issued all payments due pursuant to the coverages available under the subject policy. • Failing to adopt and implement standards for the proper investigation of claims – This allegation is baseless, as Underwriters’ investigation included inspections by an independent adjuster and engineer. Underwriters further reopened the investigation after the Public Adjuster submitted an estimate by sending an engineer to the subject property to assure its investigation was as thorough as possible. • Failing to acknowledge and act promptly upon communications with respect to claims – This allegation is baseless. Underwriters promptly acted on all communications received by the insureds and/or their representatives during the investigation of the claim. • Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue – This allegation is baseless. The facts and policy provisions which supported Underwriters’ partial denial of the claim are accurately reflected in communications with the insured’s representatives and accurately describe the available coverages. • 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 – This allegation is baseless. Underwriters promptly acted on all communications received by the insureds and/or their representatives during the investigation of the claim. This allegation is baseless. Underwriters promptly acted on all communications received by the insureds and/or their representatives during the investigation of the claim. Further, the facts and policy provisions which supported Underwriters’ partial denial of the claim are accurately reflected in communications with the insured’s representatives and accurately describe the available coverages. V. Conclusion Underwriters specifically denies any and all allegations contained within the Civil Remedy Notice of Insurer Violation including, but not limited to, those allegations contained within “Reason for Notice” including any claim for bad faith. Underwriters’ decision to partially deny the insured’s claim was in accordance with its rights pursuant to Florida law and the subject policy. There are no benefits due or owing at this time to either the Claimant or the insureds and, as such, no attorneys’ fees are due or owing. The facts referenced in the Civil Remedy Notice are inaccurate, incomplete and premature. Underwriters have not acted in bad faith. Claimant has not produced any evidence to substantiate the aforementioned allegations. Furthermore, the bare nature of the Civil Remedy Notice does not allow for a more specific response to the alleged violations. Underwriters will provide a further response and consider the same if and when any additional information is provided relative to any alleged violation. Underwriters continue to reserve all of their rights. We trust this fully and adequately responds to any inquiry regarding the instant claim. If you have any questions or require further clarification with regard to the above, please do not hesitate to contact us. Sincerely, Robert K. Guinn Klyde Bedford
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