Civil Remedy Notice of Insurer Violations
Login

Filing Number:     808307
Filing Accepted:  2/25/2025
         Print Filing
Complainant
Last/Business Name *  
HSIANG WU   First Name   HSU
Street Address * 5409 TILDENS GROVE BOULEVARD
City, State Zip * WINDERMERE, FL 34786
Email Address * WANGZHENGNAN512@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HSIANG WU   First Name   HSU
Policy # * 24AVH0001573 Claim #* 20.31576
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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):* JAMIE COSTEA, DAVID BROWN, P.E., DAVID ALBERT, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, CERTAIN UNDERWRITERS AT LLOYD'S, LONDON SUBSCRIBING TO POLICY NO. 24AVH0001573 WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.70131 (1)(a) - Upon an insurer's receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer's claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer. 627.70131(7)(a)Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer's claim payment is less than specified in any insurer's detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. 627.4137(1)(e) Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: A copy of the policy. Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Certain Underwriters at Lloyd's, London Subscribing to Policy No. 24AVH0001573 (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) failing to provide an estimate that complies with the Florida Building Codes; 10) failing to render a claims determination within sixty (60) days; 11) failing to acknowledge and act promptly upon communications with respect to claims; 12) misrepresenting the terms of the insurance policy; and 13) failing to provide a copy of the insurance policy within 30 days. On or about October 9, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by Hurricane Milton. The areas impacted include but are not limited to the roofing system, gym, and garage. The Insured timely submitted a claim on October 10, 2024, to the Insurer for hurricane damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 20.31576 to the loss and sent a field adjuster to inspect the property on October 12, 2024. The Insurer also retained an engineer who inspected the property on October 25, 2024. Then in a letter dated December 4, 2024, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $16,169.20 to restore the insured property to its pre-loss condition, which failed to exceed the policy deductible. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer erroneously denied coverage for the damage to the Insured's tile roof. This coverage decision is incorrect. Denying coverage for the damage was wrongful as the damages are covered under the policy. Given the partial denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from Hurricane Milton, the Insured retained a public adjuster. On December 17, 2024, the public adjuster sent the Insurer a letter of representation, which also requested several documents including a copy of the insurance policy. In violation of Fla. Stat. 627.70131 (1)(a), the Insurer failed to acknowledge or respond to this communication within 7 days. The next day the public adjuster sent a claims package, which included photographic evidence of the damage and a repair estimate. The estimate calculated the replacement cost value of the loss at $234,372.30 in covered damage to the dwelling. The Insurer continued to violate Fla. Stat. 627.70131 (1)(a) by failing to again acknowledge or respond to this communication within 7 days. The public adjuster sent follow-up email requests for acknowledgment of his letter of representation on December 27, 2024, January 2, 7, 10, 15, 20, 23, 28, 31, and February 5, 2025. The Insurer failed to acknowledge or respond to any of these communications. Lastly, the public adjuster sent the Insurer an updated claims package with a revised repair estimate on January 8, 2025. The Insurer never acknowledged or responded to this communication. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's engineer observed damage to the tile roof but attributed the cause of this damage to several causes excluded under the policy. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. Additionally, although there was interior water damage the adjuster did not use a moisture meter. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that Insurer significantly underestimated the scope of the loss to the Insured's property. Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. This is an underhanded attempt to place the financial interest of Insurer over those of the Insured, to delay the Insured's claim, and to delay the Insured in restoring his property to its pre-loss condition. The Insurer continued to delay and frustrated the Insured's ability to have his claim adjusted promptly to begin restoring his property by failing to timely provide the Insured with the policy after requested by the Insured through his representatives. The Insured, through his representatives, requested the policy on December 17, 2024. The policy was not received within 30 days of the first written request of the Insured. Each Insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the Insured, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent, a copy of the policy. Fla. Stat. 627.4137(1)(e). The Insurer has placed obstacles to its Insured's ability to have the claim adjusted promptly to begin restoring the home by waiting more than sixty (60) days after receiving notice of the Insured's claim to make a claims determination. The Insured's public adjuster first reported a supplemental claim on December 17, 2024. The Insurer has yet to render a claims determination. Under Fla. Stat. 627.70131(7)(a), "[w]ithin 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer." (Emphasis added). There are currently no factors outside of the Insurer's control. The Insurer has inspected the property twice and received a repair estimate and photographic evidence of the damage. As the Insurer has failed to make a timely determination, it has violated this code. As such, in addition to the below requirements to cure this CRN, any payment made to the Insured must contain interest for the damage as a result of the loss from the date the Insurer received first notice of the loss. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for the damage to the Insured's tile roof as well as wrongfully determining that it would only require $16,169.20 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Failing to provide an estimate that complies with the Florida Building Codes 10. Shifting the burden of investigating onto the Insured 11. Conducting inadequate investigations 12. Failing to render a written claims determination to the Insured within 60 days 13. Making material misrepresentations 14. Failing to acknowledge and act promptly upon communications with respect to claims 15. Failing to provide a copy of the insurance policy within 30 days Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-Mail: Certain Underwriters at Lloyd's, London Subscribing to Policy No. 24AVH0001573 14 W. Patrick St., Suite 201 Frederick, MD 21701 mma@millsmehr.com
Comments
User Id Date Added Comment
grant@krapflegal.com 02-09-2026 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice.
Taylor.davis@clydeco.us 04-25-2025 To Whom it May Concern: Please accept this correspondence as Certain Underwriters at Lloyd's, London's ("Underwriters") response to the Civil Remedy Notice number 808307 filed on behalf of Hsu Hsiang Wu ("Hsu" or the "Insured") and dated February 25, 2025 ("CRN"). The content of this submission was sent to Hsu's counsel via email and US mail on April 25, 2025. In sum, Underwriters respectfully disagrees with the allegations in the CRN and maintain that it has acted in good faith at all times. The Policy Underwriters issued a homeowners policy of insurance to Hsu bearing policy number 24AVH0001573 for a policy period of July 3, 2024, to July 3, 2025 (the "Policy"). The Policy is a written document, the terms and conditions of which speak for themselves. The Policy insured Hsu's property, located at 5409 Tildens Grove Boulevard, Windermere, Florida 34786, which was originally constructed in 2004 (the "Property"). The Property is a single-family residence that was leased to a tenant at the time of the alleged loss. The Policy's declarations, Item 4., provides for the following limits of coverage for Section I – Property Coverage: Coverage A: Dwelling $1,200,000, Coverage B: Other Structures $60,000, Coverage C: Personal Property $120,000, and Coverage D: Loss of Use $120,000. Item 4 further states that the "Wind/Hail" deductible is "2% of Coverage A" for "Each and Every Occurrence." Coverage under the Policy is subject to the terms, conditions, provisions, definitions and exclusions contained therein. We set forth additional pertinent provisions of the Policy as appropriate below. The Loss, Investigation and Coverage Determination The Insured claims to have suffered a loss resulting from Hurricane Milton on or about October 9, 2024 (the "Loss"). The Insured filed a claim for the Loss on October 10, 2024 (the "Claim"). The Third-Party Service Provider for the handling of the Claim, as stated in the Policy, is Mills, Mehr & Associates, Inc. ("MMA"). On October 11, 2024, Christy Lalumia with MMA emailed a claim acknowledgment to the Insured. MMA explained that MMA was assigned to act as the Delegated Claims Administrator ("DCA") on behalf of Underwriters. MMA also provided the Insured with a claim number and advised that the claim contact would be Jamie Costea, Senior Account Manager with MMA. On October 12, 2024, David Albert, Field Adjuster with MMA, inspected the Property. Albert ascertained that the Insured had retained a roofer prior to this inspection. Albert observed no evidence of flooding at the Property, nor did he observe any storm-created openings during this inspection. Albert observed limited wind damage on the roof, dislodged ridge tiles, damaged field tiles, damaged soffit, roof debris, damage to the garage ceiling above the water heater, damage to the gym ceiling, damage to the metal fence caused by fallen roof tiles, and damage to an electrical utility. On October 17, 2024, MMA emailed a reservation of rights letter to the Insured. In the letter, MMA explained that, during the inspection, the field adjuster, Albert, observed damage that could be caused by wear, tear, deterioration, and/or lack of maintenance. MMA advised that additional clarification was needed to determine causation of the claimed damage to the roof and the claimed interior water damages. MMA explained that an engineer had been assigned to further investigate the scope of damages, and that MMA was investigating the exact cause of loss and the evaluation of any covered damages. In sum, MMA explained to the Insured that additional information was required and the purpose of that information. The same day, on October 17, 2024, MMA retained Keystone Experts and Engineers ("Keystone") to assist with an evaluation of the Property's roof to determine causation of the damage to the tiles. Just one week later, on October 25, 2024, the Keystone Field Expert, Professional Engineer David Brown, inspected the Property. Whitney Martinez, the tenant of the Property, was present during the inspection. Keystone determined that a portion of the observed conditions at the Property were not storm-related nor the result of storm-created openings. Rather, some of the damages were caused by wear and tear, shrinkage, and faulty construction. The Policy contains the following exclusionary provisions for, among other things, loss caused by wear and tear, deterioration, shrinkage, and faulty construction and/or maintenance: SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against direct physical loss to property described in Coverages A and B. 2. We do not insure, however, for loss: a. Excluded under Section I – Exclusions; . . . c. Caused by: . . . (6) Any of the following: (a) Wear and tear, marring, deterioration; (b) Mechanical breakdown, latent defect, inherent vice or any quality in property that causes it to damage or destroy itself; . . . (f) Settling, shrinking, bulging or expansion, including resultant cracking, of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs or ceilings; *** SECTION I – EXCLUSIONS . . . B. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not precluded by any other provision in this policy is covered. . . . 3. Faulty, inadequate or defective: . . . b. Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; c. Materials used in repair, construction, renovation or remodeling; or d. Maintenance; of part or all of any property whether on or off the "residence premises". Keystone determined that some of the claimed damages were caused by improper shunts, unsupported tiles at valley cuts, and insufficient fastening during installation as well as shrinkage of the concrete tiles and foot traffic loads, and not attributable to any storm-created openings caused by Hurricane Milton. Accordingly, in a partial denial of coverage letter dated December 4, 2024, MMA provided the Insured with a copy of the Keystone report and advised the Insured that these damages were excluded from coverage pursuant to the foregoing provisions in the Policy. Keystone concluded that the roof of the Property did not warrant replacement and instead could be repaired. Keystone determined that wind forces displaced approximately ten (10) feet of soffit vents on the southwest corner of the roof, and approximately ten (10) cap tiles along the left-rear roof hip. Accordingly, based upon Keystone's investigation and the initial inspection, MMA prepared an estimate for the Property that included repairs to the ridge cap tiles and soffit damages, as well as costs for the claimed fence damage and interior water damages. Per the prepared estimate for covered damages, the dwelling damage was $14,415.38 and the other structures damage was $1,753.82 which totaled $16,169.20 at replacement cost. This total does not exceed the Wind/Hail policy deductible of $24,000.00 that applies to the Claim. The Policy contains the following "Windstorm or Hail Percentage Deductible" condition: SECTION I – CONDITIONS B. Deductible The following special deductible is added to the policy: With respect to the peril of Windstorm Or Hail, for any one loss, we will pay only that part of the total of all loss payable that exceeds the windstorm or hail percentage deductible. The dollar amount of the windstorm or hail deductible is determined by multiplying the Coverage A Limit Of Liability shown in the Declarations by the deductible percentage amount shown in the Schedule above. No other deductible in the policy applies to loss caused by windstorm or hail. All other provisions of this policy apply. The Schedule specifies the deductible percentage amount is "2% of Coverage A, Each and Every Occurrence." As explained in the aforementioned letter dated December 4, 2024, the Wind/Hail policy deductible that applies to this Claim is $24,000.00. Accordingly, because the total amount of covered damages, $16,169.20, did not exceed the applicable deductible, no payment was owed or issued by Underwriters. Subsequently, on December 17, 2024, Costea with MMA received the Insured's Letter of Representation ("LOR") from Ask An Adjuster ("AAA"). In the email with the attached LOR, Kristina LaPetina, Document Collection Specialist with AAA, requested a certified or digital copy of the Policy. Costea replied to the LOR email on the same date and attached copies of the Policy, the Reservation of Rights letter, and the partial denial letter originally issued on December 4, 2024, with the engineering report attached. Notwithstanding Keystone’s findings that any covered loss to the roof could be repaired, the Insured submitted two estimates for replacement cost value which included significant replace costs values for roofing. This is despite the Policy’s language stating that a covered loss for roof surfacing caused by windstorm or hail is subject to actual cash value loss settlement. On December 18 and 19, 2024, AAA emailed MMA a "complete claim package and photo report of additional photographic documentation of [the] Loss." This “complete claim package” contained an estimate in the amount of $234,372.30 in “RCV.” After exchanging several emails and requesting additional information from AAA to support the Claim and AAA's estimate, Jennifer Wolff with MMA emailed AAA an updated letter reiterating the partial denial of coverage position on February 7, 2025. Wolff attached another copy of the engineering report to this letter. Finally, despite the foregoing, AAA submitted a new estimate, in the amount of $193,148.20 in “RCV” along with a purported “Sworn Statement in Proof of Loss” on February 20, 2025. Underwriters did not request such a proof. Underwriter promptly responded to the February 20, 2025 submission by letter of February 27, 2025, wherein Underwriters rejected the proof of loss, and reasserted its prior coverage determination as noted above. Moreover, despite repeated requests for any expert or engineering opinion rebutting Keystone’s finding that the roof did not need to be replaced, the Insured failed to provide any. Curing the CRN With respect to "cure," the CRN provides that Underwriters may cure the CRN by "[a]dmit[ting] full coverage for the Insured's [L]oss," and "[t]ender[ing] full benefits owed to the Insured under the insurance contract." As an initial matter, it is unclear what precisely is meant by "[a]dmit full coverage for the Insured's loss." For the purposes of responding to this request, we assume this is in reference to the partial denial of coverage Underwriters issued for this Claim. As explained in the foregoing section of this response, pursuant to the multiple investigations conducted by the professionals engaged by Underwriters, including a professional engineer, Underwriters determined that some of the damages claimed by the Insured were not caused by Hurricane Milton. Specifically, the investigations revealed there were no storm-created openings to the Property. Rather, some of the observed damages were caused by wear and tear, shrinkage, cracking, marring, deterioration, and/or faulty or improper design, specifications, workmanship, repair, construction, materials, and/or maintenance. Specifically, the professional engineer concluded the following in regard to the claimed damages: • The numerous cracked and slipped tiles were caused by improper shunts, unsupported tiles at valley cuts, and insufficient fastening during installation as well as shrinkage of the concrete tiles and foot traffic loads. • The moisture stains on the ceiling of the gym room and bar were caused by wetting of the material from water that migrated through the roofing system at concealed deficiencies near the intersection of the roof and upper walls. o The moisture stains were not caused by a storm-created opening. o The moisture stains were characteristic of a single or low number of wetting events. Such damages are excluded from coverage pursuant to the aforementioned provisions in the Policy. The multiple investigations did determine that some observed damages were likely caused by wind forces. However, the investigation showed that the observed covered damages could be repaired and that the roof did not warrant replacement. But, as detailed above, the total costs of those damages did not exceed the applicable deductible. In the CRN, the Insured also asked that Underwriters "tender full benefits owed to the Insured under the insurance contract." As explained in the foregoing section of this response, the Policy requires payment of benefits to the Insured only in the amount of the total of all loss payable that exceeds the applicable deductible amount. Because the total amount of covered damages in this Claim does not exceed the applicable Wind/Hail deductible, Underwriters did not issue—and do not owe—any payment to the Insured arising from the Claim or Loss. Accordingly, the Insured's proposed method of "cure" is inappropriate. The Civil Remedy Notice and Underwriters' Response In the CRN, the Insured alleges that Underwriters has violated six Florida statutory provisions. While the CRN is essentially devoid of factual support for any of the Insured's allegations, Underwriters will respond to the individual statutes it is alleged to have violated, all of which Underwriters denies violating. 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. The foregoing statute does not require Underwriters to pay a claim that is below the applicable deductible or one that is simply not covered. The Florida Supreme Court "expressly hold[s] that a claim for bad faith pursuant to section 624.155(1)(b)(1) is founded upon the obligation of the insurer to pay when all conditions under the policy would require an insurer exercising good faith and fair dealing towards its insured to pay." Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla. 2000). However, the Florida Supreme Court also "point[ed] out that the denial of payment does not mean an insurer is guilty of bad faith as a matter of law." Id. Further, "[t]he insurer has a right to deny claims that it in good faith believes are not owed on a policy. Even when it is later determined by a court or arbitration that the insurer's denial was mistaken, there is no cause of action if the denial was in good faith." Id. Here, based on the investigations and findings of its retained consultants, including a professional engineer, Underwriters properly evaluated the Insured's Claim, properly denied the portions of the Claim that included uncovered damages, and correctly applied the deductible to those damages that were covered. Underwriters did so based not only on its thorough investigations, but also on the plain and unambiguous language of the Policy itself. Given the attendant factual circumstances, Underwriters appropriately exercised its right to deny those portions of the Claim that it, in good faith, believe are not covered under the Policy. 626.9541(1)(i)(2) Making a material misrepresentation to an insured 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. This subsection is inapplicable to this Claim. The Insured has not set forth what "material misrepresentation" was allegedly made by Underwriters to the Insured for the purpose of effecting settlement of the Claim on less favorable terms than those provided in the Policy. No such misrepresentation was made by Underwriters. Instead, Underwriters set forth its reservation of rights letter based on the information known at the time of its drafting and its coverage determination through three letters, one sent on December 4, 2024, the second on February 7, 2025, and the third sent on February 27, 2025, each time taking into account any new information Underwriters had received. Underwriters' intent was to apprise the Insured of its determination, not to effect settlement on less favorable terms than contemplated by the Policy. Additionally, the Insured alleges that Underwriters misrepresented the Loss and wrongfully denied coverage in light of the concurrent cause doctrine. Underwriters disputes the Insured's misapplication of the concurring cause doctrine to the Claim here. Underwriters' multiple investigations concluded that some of the claimed damages were caused exclusively by excluded causes of loss, such as wear and tear, shrinking, and faulty construction. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. This subsection is inapplicable. The Insured has set forth no facts in support of this allegation, let alone identified what "standards" Underwriters failed to adopt or implement. Underwriters did not fail to adopt or implement standards for the proper investigation of the Claim or other claims. Instead, Underwriters undertook a full investigation of the Claim, including by retaining independent consultants to assist in its evaluation. Underwriters seeks to properly investigate all claims it receives, and this Claim is no different. Underwriters, through MMA, took all necessary steps to evaluate the cause and scope of the Loss and apply the applicable provisions of the Policy. 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Underwriters did not make misrepresentations regarding the facts or the Policy. The Insured has not set forth what "pertinent facts or insurance policy provisions" were misrepresented by Underwriters to the Insured. In fact, the CRN itself notes that the alleged violations "do not rely on any specific policy language." Moreover, Underwriters made no misrepresentations relating to the coverages at issue. Instead, in addition to its reservation of rights, Underwriters sent three letters, one sent on December 4, 2024, the second on February 7, 2025, and the third on February 27, 2025, explaining its coverage decision. Each of the aforementioned letters considered any additional information provided by the Insured and included relevant policy provisions. The facts set forth in Underwriters' communications are based on Underwriters' investigation and the professional opinions of Underwriters' consultants. Underwriters is not aware of any contrary information. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. This subsection is inapplicable to the factual circumstances here. As explained in more detail below under the section addressing § 627.70131(1)(a), Underwriters and its representatives consistently acknowledged and acted promptly upon communications from the Insured and the Insured's representatives with respect to the Claim. The facts demonstrate that Underwriters engaged in constant, ongoing, back-and-forth communication with the Insured and the Insured's representatives regarding the Claim along with discussion with the tenants of the Property. Accordingly, Underwriters has more than complied with its obligations. 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. Underwriters conducted a more than reasonable investigation and issued its coverage position letters based on said investigation and the unambiguous language of the Policy. Underwriters retained Professional Engineer David Brown with Keystone Experts and Engineers to assist with an evaluation of the Property's roof to determine causation of the damage to the tiles. The Insured references a lack of a moisture meter in the CRN, but the report prepared by the professional engineer, which was provided to the Insured, clearly shows the employment of a moisture meter, making this assertion factually inaccurate. The Insured has not specified anything else it believes Underwriters could have done or how Underwriters' investigation was unreasonable. Further Statutes Cited by the Insured and Response In addition to the foregoing, in the section of the CRN where the Insured is required to "[r]eference . . . specific policy language that is relevant to the violation, if any," the Insured failed to reference any specific policy language, instead stating that the violations "do not rely on any specific policy language." Again, this deficiency demonstrates the lack of a good-faith basis for disputing Underwriters' coverage position letters, which do refer the Insured to specific terms of the Policy. Instead, the Insured simply lists three additional Florida statutes it alleges Underwriters violated. Again, the CRN is essentially devoid of factual support for any of the Insured's allegations in regard to these additional statutory provisions. Nevertheless, Underwriters will respond to the individual statutes it is alleged to have violated, all of which Underwriters denies violating. 627.70131(1)(a) Upon an insurer's receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. Underwriters' communication with the Insured was both substantively and procedurally proper. Moreover, the communication was continuous. The Insured alleges that Underwriters failed to acknowledge or respond to the email from the Insured's public adjuster sent on December 17, 2024, in which the public adjuster requested a copy of the Policy, within seven (7) days in violation of Florida Statute § 627.70131(1)(a). This allegation is factually incorrect. As explained above, Underwriters did respond to the email from AAA within seven (7) days. On behalf of MMA, Costea sent a response email to AAA on the same date, December 17, 2024, and attached a copy of the Policy. Next, the Insured alleges that Underwriters failed to acknowledge or respond to certain claims documents, including an email sent by the AAA Claim Documents general email on December 18, 2024, which included an attached claims package. This allegation is also factually incorrect. Costea, on behalf of MMA, responded to AAA via email on December 20, 2024, stating, in part, "We are in receipt of the estimate presented." Adams with AAA acknowledged Costea's response by emailing back, "Thank you," on December 20, 2024. Moreover, Underwriters provided its second position letter on February 7, 2025, which included consideration of these documents. The Insured then alleges that Underwriters failed to acknowledge emails from AAA on multiple subsequent dates. These allegations are also incorrect and Underwriters disputes that it failed to respond timely to any correspondence that it actually received. Underwriters deny that AAA made follow ups to its letter of representation or other correspondence that were not timely responded to throughout the adjustment of the Claim. Further, after MMA received a sworn proof of loss on February 20, 2025 Underwriters promptly evaluated its contents and responded via letter on February 27, 2025. As the above timeline demonstrates, the Insured's representative, AAA, and Underwriters' representatives with MMA were engaged in constant, ongoing, back-and-forth communication regarding the Claim during the period from December 17, 2024, to February 27, 2025. Underwriters denies that it failed to respond to any substantive communications from AAA within seven (7) days. The Insured's allegation that Underwriters "failed to acknowledge or respond to any of these communications" is patently false. 627.70131(7)(a) Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. Underwriters’ actions from initial notice through conclusion of the claim were timely. The Insured states that Underwriters "fail[ed] to render a claims determination within sixty (60) days." This allegation is factually incorrect. The statute that the Insured appears to reference here is Florida Statute § 627.70131(7)(a), which requires payment or denial of a claim or portion of a claim within sixty (60) days. The Insured first presented the Claim on October 10, 2024. Costea, on behalf of MMA, emailed the Insured a partial denial letter on December 4, 2024, within the time permitted by law. The Insured admits as much in the following paragraph of the CRN ("The Insured timely submitted a claim on October 10, 2024, . . . [t]hen in a letter dated December 4, 2024, the Insurer notified the Insured that it was extending partial coverage for the loss."). Accordingly, Underwriters complied with the statutory requirement by denying a portion of the Claim within sixty (60) days and stating that the balance of the Claim fell below the deductible. The Insured later argues that their representative, AAA, presented a "supplemental claim" on December 17, 2024, and that Underwriters "has yet to render a claims determination" for said supplemental claim. Underwriters disputes that this constitutes a supplemental claim as it was simply an estimate for the same Claim. Additionally, even if this did constitute a supplemental claim, Underwriters was not in violation of § 627.70131(7)(a). First, Wolff, on behalf of MMA, emailed an updated letter reiterating the coverage position with a copy of the engineering report to Seth Adams with AAA on February 7, 2025. Accordingly, AAA was provided a partial coverage denial and explanation of the application of the deductible within the sixty (60) day period required by the statute. After submission of the proof of loss, Underwriters promptly considered the information provided and issued its final position letter on February 27, 2025. Further, the statute provides that an insurer must pay or deny a claim or portion of a claim within sixty (60) days "unless the failure to pay is caused by factors beyond the control of the insurer." Id. "Factors beyond the control of the insurer" include "[a]ctions by the policyholder or the policyholder's representative which constitute . . . lack of cooperation . . . regarding the claim for which benefits are owed when such actions reasonably prevent the insurer from complying with any requirement of this section." Fla. Stat. Ann. § 627.70131(5)(a). As outlined in more detail below in the discussion of the communications between MMA and AAA, MMA advised AAA on multiple occasions that Underwriters' investigation and engineering report did not support AAA's allegation that the Property warranted a full roof replacement. Accordingly, MMA requested additional documentation on multiple occasions from AAA to support AAA's estimate and conclusions. AAA refused to provide any additional information in support of its estimate and conclusions. Therefore, AAA refused to fully cooperate with Underwriters' investigation, thereby inhibiting Underwriters' further evaluation of AAA's estimate. And as a final issue regarding § 627.70131(7)(a), the statute provides that "failure to comply with this subsection does not form the sole basis for a private cause of action." Id. In interpreting this statute and this excerpt in particular, the Eleventh Circuit has explained that "Florida law interprets the [foregoing] language . . . as 'clos[ing] the door on any insured unless there is a viable independent cause of action' to seek interest on their claim." Riley v. Heritage Prop. & Cas. Ins. Co., No. 23-11678, 2025 WL 574244, at *2 (11th Cir. Feb. 21, 2025) (quoting State Farm Fla. Ins. Co. v. Silber, 72 So. 3d 286, 290 (Fla. 4th DCA 2011). "In other words, Subsection [7(a)] bars any private action predicated solely on non-compliance with Subsection [7(a)]." Id. Accordingly, the Insured here cannot allege noncompliance with § 627.70131(7)(a) to support a viable independent cause of action. 627.4137(1)(e) Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: A copy of the policy. The Insured alleges that Underwriters "fail[ed] to provide a copy of the insurance policy within [thirty (30)] days." This allegation is factually incorrect. This appears to be a reference to the Insured's previous citation of Florida Statute § 627.4137(1)(e). The statute provides, "Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: . . . (3) A copy of the policy." Id. (emphasis added). First, the Insured seeks first party coverage as evidenced by the CRN, rather than liability coverage. Second, the statute's reference to a request from the "claimant" refers to a third-party claimant, not the purchaser of the policy. Even if the statute did otherwise apply, Costea, on behalf of MMA, sent the Policy to Adams on December 17, 2024, the same date he requested it. Therefore, Underwriters complied with the statutory requirements, to the extent applicable, by supplying a copy of the Policy to the Insured's representatives within thirty (30) days of the initial request. Alleged Actions by Underwriters and Reponses At the start of the section of the CRN regarding "the facts and circumstances giving rise to the insurer's violations as you understand them," the Insured provides a list of alleged acts committed by Underwriters in the handling of the Insured's Claim. Additionally, towards the end of the CRN, the Insured sets forth fifteen alleged actions taken by Underwriters. Several of these allegations are the same or similar. Each is addressed below. The alleged actions are numbered, but because there are two lists, there are two sets of the same numbers. Accordingly, in order to efficiently and thoroughly address each and every allegation set forth by the Insured, these have been labeled as a number followed by either "a." or "b." (e.g., "1.a." and "1.b."). Numbers followed by "a." refer to the list that comes first in the CRN, and numbers followed by "b." refer to the list that comes second in the CRN. 3.a. Looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims. 8.a. Denying a claim which it knew or should have known the policy and Florida law provided coverage for. 1.b. Claim denial. 4.b. Looking for ways to reduce recovery to the Insured. 5.b. Looking for ways to deny recovery to the Insured. With respect to "actions" 3.a., 8.a., 1.b., 4.b., and 5.b., as noted earlier in response to the alleged statutory violations, "[t]he insurer has a right to deny claims that it in good faith believes are not owed on a policy." Vest, 753 So. 2d at 1275. The Insured has provided no evidence of any alleged "ways" Underwriters "look[ed] for" to deny or reduce recovery to the Insured. Here, Underwriters properly evaluated the Insured's Claim, properly denied the portions of the Claim that included uncovered damages and causes of loss, and did not make payment for covered damages based upon the fact that the total amount of covered damages did not exceed the applicable deductible under the Policy. Underwriters did so based not only on its investigations, but also on the plain and unambiguous language of the Policy itself. Given the attendant factual circumstances, Underwriters appropriately exercised its right to deny those portions of the Claim that it, in good faith, believe are not covered under the Policy. Thus, while Underwriters did deny a portion of the Claim, it did so correctly and did not commit any of the acts identified above. 4.a. Not adjusting the claims promptly and fairly. 2.b. Claim delay. With respect to "actions" 4.a. and 2.b., the Insured has provided no evidence of any alleged "claim delay" by Underwriters, and Underwriters denies that any delays occurred. Underwriters promptly acknowledged and investigated the Insured's Claim. In fact, the Insured filed the Claim on October 10, 2024, Underwriters acknowledged the Claim on October 11, 2024, and Underwriters inspected the Property on October 12, 2024. When the Insured's representative, AAA, sent in its "claim package," Underwriters responded within two days to confirm receipt of the same. Additionally, Underwriters immediately began reviewing and evaluating AAA's "claim package." In addition to its written letters, through its representatives, Underwriters remained in contact with the Insured and the Insured's representatives regarding the status of the Claim. Thus, the adjustment of the Claim was not delayed, and the Claim was adjusted promptly and fairly. 1.a. Failure to act in due diligence and good faith to resolve claims. 5.a. Not attempting in good faith to settle claims. 3.b. Not treating the Insured with good faith claims conduct. With respect to "actions" 1.a., 5.a., and 3.b., the Insured has provided no evidence of any alleged acts by Underwriters that constitute a failure to act in good faith. Underwriters maintains that its investigation was proper and that it treated the Insured with the utmost good faith. As discussed at length above, Underwriters have made no material misrepresentations, have not failed to adopt and implement standards for the proper investigation of claims, have not misrepresented pertinent facts or insurance policy provisions, have not failed to acknowledge and act promptly with respect to the Claim, have not denied the Claim without conducting reasonable investigations based upon available information, have not failed to affirm or deny full or partial coverage of claims, have not failed to promptly provide a reasonable explanation in writing to the Insured of the basis in the insurance Policy for the partial denial of the Claim, have not failed to promptly notify the Insured of any additional information necessary for the processing of the Claim, and have not failed to clearly explain the nature of the requested information and reasons for the same. 6.a. Conducting inadequate investigations. 7.a. Failing to employ policies and procedures to conduct adequate investigations. 6.b. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured. 10.b. Shifting the burden of investigating onto the Insured. 11.b. Conducting inadequate investigations. With respect to "actions" 6.a., 7.a., 6.b., 10.b., and 11.b., the Insured has provided no evidence that Underwriters conducted an inadequate investigation, failed to employ policies and procedures for adequate investigation, or failed to provide any indemnity that was actually owed. As explained above under "action" 2.b, Underwriters promptly acknowledged and investigated the Insured's Claim. Additionally, as discussed at length above, Underwriters conducted proper and fair investigations and evaluations based upon the available information. Underwriters, at its own expense, retained Professional Engineer David Brown with Keystone Experts and Engineers to inspect the Property. The Insured has alleged that Underwriters failed to use a moisture meter in its investigations. But the report prepared by the professional engineer retained by Underwriters, which was provided to the Insured, clearly shows the employment of a moisture meter, making this assertion factually inaccurate. Other than this assertion, the Insured has not specified what more it believes Underwriters could have done or how Underwriters' investigation was improper, delayed, or unfair. Underwriters denies that it shifted any burden of investigating onto the Insured. 2.a. Placing the financial interest of Insurer before that of the policyholder and the Insured. 7.b. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests. 8.b. Placing the financial interest of the Insurer over that of the health and safety of the Insured. With respect to "actions" 2.a., 7.b., and 8.b. the Insured has failed to provide any supporting factual information, outside their disapproval of Underwriters' coverage position. First, the Insured has provided no evidence of any alleged failure by Underwriters to train, supervise, or manage adjusters properly or that it placed Underwriter's interests before the Insured's interests. As discussed at length above, Underwriters and its representatives properly and promptly adjusted, investigated, and evaluated the Insured's Claim. As set forth at length herein, the investigation was prompt and thorough and the Insured has failed to identify any additional training, supervision or management that Underwriters should have employed. Further, although the investigation and policy language at issue did not result in a payment to the Insured, the evaluation of a loss and applicable policy language does not constitute Underwriters placing its own financial interests before the Insured's interests. Moreover, the Insured has provided no evidence of any alleged action by Underwriters which constitutes "[p]lacing the financial interest of the Insurer over that of the health and safety of the Insured." In fact, the Insured has never contended that its health and safety were at issue in this Claim. Underwriters has not placed its financial interest over that of the health and safety of the Insured. Rather, Underwriters properly evaluated the Insured's Claim, properly denied the portions of the Claim that included uncovered damages and causes of loss, and denied payment for covered damages based upon the fact that the total amount of covered damages did not exceed the applicable deductible under the Policy. Underwriters did so based not only on its investigations, but also on the plain and unambiguous language of the Policy itself. Given the attendant factual circumstances, Underwriters appropriately exercised its right to deny those portions of the Claim that it, in good faith, believe are not covered under the Policy. 9.a. Failing to provide an estimate that complies with the Florida Building Codes. 9.b. Failing to provide an estimate that complies with the Florida Building Codes. With respect to "actions" 9.a. and 9.b., the Insured has provided no evidence of any alleged failure by Underwriters "to provide an estimate that complies with the Florida Building Codes." Nor has the Insured set forth which specific Florida Building Codes it believes Underwriters' estimate does not comply with. Underwriters provided an estimate to the insured, and Underwriters denies that its evaluations and estimates do not comply with Florida Building Codes to the extent applicable. 10.a. Failing to render a claims determination within sixty (60) days. 12.b. Failing to render a written claims determination to the Insured within 60 days. "Actions" 10.a. and 12.b. are factually incorrect. As discussed at length above, the Insured first presented the Claim on October 10, 2024. Costea, on behalf of MMA, emailed the Insured a coverage position letter on December 4, 2024, which was less than sixty (60) days from the first notice of the Claim. The Insured admits as much in the CRN ("The Insured timely submitted a claim on October 10, 2024, . . . [t]hen in a letter dated December 4, 2024, the Insurer notified the Insured that it was extending partial coverage for the loss."). Accordingly, Underwriters complied with the statutory requirement by denying a portion of the Claim within sixty (60) days. The Insured later argues that their representative, AAA, presented a "supplemental claim" on December 17, 2024, and that Underwriters "has yet to render a claims determination" for said supplemental claim. Underwriters disputes that this constitutes a supplemental claim as it was simply an estimate for the same Claim. Additionally, even if this did constitute a supplemental claim, Wolff, on behalf of MMA, emailed an updated letter reiterating the partial denial with a copy of the engineering report to Adams with AAA on February 7, 2025. Accordingly, AAA was provided a partial coverage denial within the sixty (60) day period as required by Florida Statute § 627.70131(7)(a). Further, the statute provides that an insurer must pay or deny a claim or portion of a claim within sixty (60) days "unless the failure to pay is caused by factors beyond the control of the insurer." Id. "Factors beyond the control of the insurer" includes "[a]ctions by the policyholder or the policyholder's representative which constitute . . . lack of cooperation . . . regarding the claim for which benefits are owed when such actions reasonably prevent the insurer from complying with any requirement of this section." Fla. Stat. Ann. § 627.70131(5)(a). As outlined in more detail below in the discussion of the communications between MMA and AAA, MMA advised AAA on multiple occasions that Underwriters' investigation and engineering report did not support AAA's allegation that the Property warranted a full roof replacement. Accordingly, MMA requested additional documentation on multiple occasions from AAA to support AAA's estimate and conclusions. AAA refused to provide any additional information in support of its estimate and conclusions. Therefore, AAA refused to fully cooperate with Underwriters' investigation, thereby inhibiting Underwriters' further evaluation of AAA's estimate. And as a final issue regarding § 627.70131(7)(a), the statute provides that "failure to comply with this subsection does not form the sole basis for a private cause of action." Id. In interpreting this statute and this excerpt in particular, the Eleventh Circuit has explained that "Florida law interprets the [foregoing] language . . . as 'clos[ing] the door on any insured unless there is a viable independent cause of action' to seek interest on their claim." Riley v. Heritage Prop. & Cas. Ins. Co., No. 23-11678, 2025 WL 574244, at *2 (11th Cir. Feb. 21, 2025) (quoting State Farm Fla. Ins. Co. v. Silber, 72 So. 3d 286, 290 (Fla. 4th DCA 2011). "In other words, Subsection [7(a)] bars any private action predicated solely on non-compliance with Subsection [7(a)]." Id. Accordingly, the Insured here cannot allege noncompliance with § 627.70131(7)(a) to support a viable independent cause of action. 12.a. Misrepresenting the terms of the insurance policy. 13.b. Making material misrepresentations. With respect to "actions" 12.a. and 13.b., the Insured has not set forth what "material misrepresentations" were allegedly made by Underwriters to the Insured, or what terms of the insurance policy Underwriters "misrepresent[ed]." No such misrepresentations were made by Underwriters. Instead, Underwriters set forth its coverage determination through three letters, one sent on December 4, 2024, the second on February 7, 2025, and the third on February 27, 2025, each time taking into account any new information Underwriters had received. Underwriters also sent one reservation of rights letter. Each of the aforementioned letters included relevant and accurate policy provisions. 11.a. Failing to acknowledge and act promptly upon communications with respect to claims. 13.a. Failing to provide a copy of the insurance policy within 30 days. 14.b. Failing to acknowledge and act promptly upon communications with respect to claims. 15.b. Failing to provide a copy of the insurance policy within 30 days. "Actions" 11.a., 13.a., 14.b. and 15.b. are factually incorrect. Underwriters incorporates its response and timeline set forth throughout this response. As the above timeline demonstrates, the Insured's representative, AAA, and Underwriters' representatives with MMA were engaged in constant, ongoing, back-and-forth communication regarding the Claim during the period from December 17, 2024, to February 27, 2025. Underwriters denies that it failed to respond to any substantive communications from AAA promptly. Further, Underwriters denies that it failed to provide a copy of the insurance Policy within thirty (30) days. Conclusion Underwriters' investigation of the Claim was prompt, thorough, and more than reasonable. The Insured's simple disagreement as to the coverage position does not warrant a finding of any culpability on Underwriters' part. Further, based on the lack of information provided in the CRN and the inaccuracy of the allegations made in the CRN, the Insured has failed to perfect its right to pursue the civil remedy authorized by Section 624.155, Florida Statutes. Underwriters believes this letter is a sufficient response to the CRN but will supplement the response if necessary. Should the Department have any questions regarding this response, please do not hesitate to contact the undersigned on behalf of Underwriters. Sincerely, Taylor L. Davis Clyde & Co US LLP
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