Filing Number: 808467
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| Filing Accepted: 2/25/2025 |
| Last/Business Name
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PAULK
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First Name |
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JOE AND SABRINA |
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| Street Address
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22185 S GULFVIEW DRIVE |
| City, State Zip
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PERRY,
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32347
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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PAULK |
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First Name |
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JOE AND SABRINA |
| Policy # * |
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GH-0000154433-01 |
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Claim #* |
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HO 0524427469 |
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Attorney is Applicable
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| Last Name* |
ZATIK
First Name *
ALEX
Initial
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| Street Address* |
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4000 HOLLYWOOD BLVD, STE 685-S |
| City, State Zip* |
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HOLLYWOOD
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FLORIDA
33021
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| Email Address * |
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AZATIK@CASSEL.LAW |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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MONARCH NATIONAL INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 15715 |
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| Name of individual responsible for violation (if any):*
ROSMEY HONDARES AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY MONARCH NATIONAL INSURANCE COMPANY INVOLVED IN THIS CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Violation of Adjusters' Ethical Requirements
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(2) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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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.
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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 violations asserted herein regarding Monarch National Insurance Company's bad faith actions are based heavily on the facts and circumstances asserted in the below section designated for same as well as violations of the portions of Florida Insurance Code and Florida Administrative Code upon which the bad faith statutes contained within Sections 624.155 & 626.9541, Florida Statutes, are based.
Despite requests for a complete copy of the policy, Monarch National Insurance Company has not provided same and, as such, the exact verbiage of the terms of the subject policy are “UNKNOWN.” With that said, the based on prior experiences with policies issued by Monarch National Insurance Company or its related companies, it is anticipated that the following policy language is relevant to Monarch National Insurance Company's statutory violations and bad faith conduct:
SECTION I – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property.
SECTION I – EXCLUSIONS
1. We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects
c. Water Damage meaning:
(1) Flood, surface water, waves, including tidal wave and tsunami, tides, tidal water, overflow of a body of water, or spray from any of these, all whether or not driven by wind including storm surge;
(2) Water, water-borne material, sewage or any other substance which backs up through sewers or drains or which overflows or is otherwise discharged from a sump, sump pump or related equipment; or
(3) Water or water-borne material or sewage below the surface ofthe ground, regardless of its source. This includes water which exerts pressure on or seeps, leaks or flows through a building, sidewalk, driveway, patio, foundation, swimming pool or other structure.
(4) Waterborne material carried or otherwise moved by any of the water referred to in 1.c.(1) through 1.c.(3) of this exclusion.
This Exclusion 1.c. applies regardless of whether any of the above
1.c.(1) through 1.c.(4) is caused by or resulting from human or animal forces, any act of nature or is otherwise caused.
This Exclusion 1.c. applies to, but is not limited to, escapes, overflow or discharge, for any reason of water or waterborne material from a dam, levee, seawall or any other boundary or containment system.
Direct loss by fire, explosion or theft resulting from water damage is covered.
CONDITIONS
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C. Loss Settlement
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If a total loss of the dwelling occurs, the provisions of 2.d. above do not apply and we will pay the replacement cost coverage without reservation or holdback of any depreciation in value, pursuant to Section 627.702, Florida Statutes.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Form DFS-10-363, Rev. 10/14/2008, contains a field for the insureds to include their email addresses. Prior to filing the CRN, said form contains an instruction that, in the event the insureds do not with for certain information to become part of the public record, the insureds must simply include the term “WITHHELD” to satisfy the filing requirement. This is further established through the following statement with appears on Civil Remedy Notices which have been filed:
Warning! Information submitted as part of this civil remedy notice is a public record. Data entered into this form will be displayed on the DFS website for public review. Please DO NOT enter Social Security Numbers, personal medical information, personal financial information or any other information you do not want available for public review.
As any information contained herein becomes part of the public record, the insureds have withheld their email addresses so as not to make same available for public review and indicated same accordingly. Furthermore, as the insureds are represented by counsel, it would be improper for any representative of Monarch National Insurance Company to contact the insureds directly for any reason utilizing their email addresses and, as such, the information is neither material to Monarch National Insurance Company’s ability to correct the violations contained herein nor required by the Department of Financial Services. Monarch National Insurance Company should direct all follow-up correspondences to the attorney listed above.
Furthermore, as the above section requesting people with knowledge as to the allegations in the instant CRN often gets cut off, the following are those responsible for the violations alleged herein:
Rosmey Hondares and all other adjusters, supervisors, management and individuals associated with or retained by Monarch National Insurance Company involved in this claim.
The facts and circumstances giving rise to the insurer's violation as the insureds understand them at this time:
Joe Paulk and Sabrina Paulk (hereinafter the “insureds”) purchased an all-risk property insurance policy, policy number GH-0000154433-01 (hereinafter the “Subject Policy”) from Monarch National Insurance Company (hereinafter “Monarch National”) which, at all times material hereto, provided property insurance for the property located at 22185 S Gulfview Drive, Perry, FL 32347 (hereinafter the “Subject Property”).
On or about September 26, 2024, Hurricane Helene, a covered cause of loss, caused direct physical loss and resultant/ensuing damages to the Subject Property (hereinafter the "Loss").
The insureds timely notified Monarch National of the loss. Monarch National assigned claim number HO 0524427469 to the loss (hereinafter the "claim") and assigned adjustment of the claim to Rosmey Hondares who, in turn, enlisted the assistance of a field adjuster employed by Monarch National, to perform an inspection of the Subject Property.
On October 28, 2024, the carrier denied coverage for the loss. The correspondence provides that the Defendant was unable to determine if the damage was due to flood or wind. The correspondence then alleges the carrier is relying on an engineer to deny the claim, but does not provide the report or any document authored by the engineer with their findings. The carrier failed to place the insureds on notice of the specific reasons for the denial. The correspondence is a material misrepresentation of applicable Florida law and the loss as provided. Upon information and belief, the carrier has a pattern and practice of such misrepresentations to the detriment of their insureds. As a result, the insureds have been prejudiced and continue to suffer damages.
On December 10, 2024, the insureds requested the carrier to reconsider their denial and provided additional information that provided the total loss was the result of wind. Inclusive of the documents provided was an engineering report detailing the causation of the total loss as a result of wind alone.
On or about December 29, 2024, the insured submitted a scope estimate detailing the total loss to the Subject Property. The same was provided to the carrier with the carrier failing to tender coverage consistent therewith.
On February 7, 2025, despite having information to the contrary of their prior denial, the carrier maintained their prior denial of the loss. Upon information and belief, the carrier has a pattern and practice of unilaterally adjusting losses to the detriment of their insureds. In the instant matter the carrier refused to acknowledge the veracity of the findings of the insureds’ engineer, and instead chose to deny all applicable benefits due and owing.
Monarch also failed to issue full payment for the insureds’ covered claim through their actions in violation of Florida’s Valued Policy Law (hereinafter "VPL"). Florida’s VPL, which has been in existence since 1899, provides, in pertinent part:
In the event of the total loss of any building… located in this state and insured by any insurer as to a covered peril, in the absence of any change increasing the risk without the insurer’s consent and in the absence of fraudulent or criminal fault on the part of the insured or one acting in her or his behalf, the insurer’s liability under the policy for such total loss, if caused by a covered peril, shall be in the amount of money for which such property was so insured as specified in the policy and for which a premium has been charged and paid.
Fla. Stat. § 627.702(1)(a) (2022). Furthermore, “if the covered perils alone would have caused the total loss,” coverage shall be afforded in the amount of the applicable policy limits. Id. at (b).
The VPL requires an insurance company to set its maximum liability, for which it sets an appropriate premium, in order to eliminate any dispute over the amount of loss payable where the insured loss is total. The Subject Policy carries with it a Coverage A limit of $307,000, a Coverage B limit of $6,140, a Coverage C limit of $76,750 and a Coverage D limit of $61,400.
The Valued Policy Law... sets the amount payable when there is a total loss. ‘Its principle object and purpose is to fix the measure of damages in case of loss total, or partial; and, to this end, it requires the insurer to ascertain the insurable value at the time of writing the policy, and to write it therein.’***Undoubtedly an important object of the statute is also to simplify and facilitate prompt settlement of insurance claims when a total loss occurs… Thus vexatious contest on this [value of the property] issue would persist when the best interests of all demanded prompt settlement and relief from the loss. A solution to this is found in the statute which in effect requires the parties to ascertain and agree in advance what the value is and in the case of total loss by the insured peril this amount shall be paid as liquidated damages. This is not an unfair scheme, as the insured is stating the limits of his recovery and at the same time the insurer is basing his premium charges on his maximum exposure. When the total loss occurs neither can contend the value of the destroyed property is any different from what they had previously specified.
Springfield Fire and Marine Ins. Co. v. Boswell, 167 So.2d 780, 783-84 (1st DCA 1964); see also Ceballo v. Citizens Prop. Ins. Corp., 967 So.2d 811, 813 (2007)(“Florida’s VPL was originally enacted in 1899 to promote clarity and predictability for property insurers and insureds alike by predetermining the value of insured real property and having that value set out in the policy of insurance.”); Citizens Prop. Ins. Corp. v. Hamilton, 43 So.3d 746, 756 (1st DCA 2010)(“Once the jury found a total loss caused by wind, damages were fixed by statute.”).
Hurricane Helene made landfall as a Category 4 storm whose maximum sustained winds were 140 mph, per NOAA records. With Hurricane Helene, wind and wind-driven debris occurred first. This wind damage would have caused a total loss on its own. As such, Florida’s VPL is triggered and policy limits are owed.
This is further supported by the Informational Memorandum Notification to Authorized Residential Property Insurers, including Monarch, issued by the Florida Office of Insurance Regulation (hereinafter “FOIR”) on February 20, 2025. In the bulletin, the FOIR instructs that it “expects insurers, before denying a total loss claim for wind damage when flood or storm surge damage may have also damages the building . . . to be mindful of and apply the language contained in” the Florida Valued Policy Law statute. The FOIR further warns that “[i]nsurers failing to comply with Florida law and inappropriately denying coverage due to concurrent causation will be subject to additional regulatory action.” The actions of Monarch with regard to the instant claim violate the very issues warned about by the FOIR’s bulletin. Should Monarch fail to rectify this in response to the instant Notice, the FOIR will be notified regarding same, especially considering the pattern of conduct evident through counsel’s other files with Monarch.
Through its actions/inactions as outlined above, subject to the facts and circumstances understood at this time, Monarch National has improperly denied coverage in violation of the terms and conditions of the Subject Policy and governing Florida law. As such, litigation is ripe. Please note that the foregoing is a recitation of the acts and omissions of Monarch National as understood by the insureds as of the date of filing. The insureds hereby reserve their right to present additional facts upon discovery of same.
The insureds have been left with no choice but to hire an attorney in order to file a notice of intent to initiate litigation subject to Fla. Stat. § 627.70152. Based on the documentation previously submitted, Monarch National could have reversed its coverage position and afforded coverage in line with the terms and conditions of the Subject Policy and governing Florida law or, at a minimum, requested a further inspection in order to attempt to find coverage by viewing the circumstances in the light most favorable to the insureds; instead, Monarch National chose to sit back and wait before Monarch National ever thought to act in a manner inconsistent with their own self-interest, forcing the insureds into hiring an attorney, thereby coming further out of pocket and leaving less of the outstanding due and owing insurance proceeds for actual repairs. This delay in claims adjustment constitutes a pattern of de facto bad faith conduct.
Through its actions/inactions, subject to the facts and circumstances understood at this time as outlined herein, Monarch National has violated the following sections of Florida Statutes:
§624.155(1)(b)(1)
Not attempting in good faith to settle claims when, under all circumstances, it could have and should have done so, had it acted fairly and honestly toward its Insured and with due regard.
§624.155(1)(b)(3)
Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
§626.9541(1)(i)(2)
A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
§626.9541(1)(i)(3)(a)
Failing to adopt and implement standards for the proper investigation of claims;
§626.9541(1)(i)(3)(b)
Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;
§626.9541(1)(i)(3)(d)
Denying claims without conducting reasonable investigations based upon available information;
§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;
Additionally, through its actions/inactions, subject to the facts and circumstances understood at this time as outlined herein, Monarch National has failed to comply with the following sections of Florida Administrative Code:
69B-220.201(3)(b)(2)
An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c)
An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(d)
An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
69B-220.201(3)(e)
An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any compensation or remuneration to himself or herself except that to which he or she is legally entitled.
69B-220.201(3)(f)
An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
69B-220.201(3)(l).
No person shall, as a company employee adjuster or independent adjuster, represent him- or herself or any insurer or independent adjusting firm against any person or entity that the adjuster previously represented as a public adjuster.
As a direct result of Monarch National's actions, the insureds have sustained irreparable harm. Upon information and belief, the aforementioned actions complained of herein, among others, are effectuated by Monarch National so often as to constitute a general business practice evidencing a motive to enhance Monarch National's profits and cause a detrimental effect to its policyholders. Monarch National clearly failed to adopt and implement standards for the proper investigations of claims. As a direct and proximate result of Monarch National's handling of the claim, the insureds sustained extra-contractual damages, including, but not limited to, a public adjuster's fee and attorneys’ fees and costs. Monarch National's implemented claims programs and practices that were improper which directly resulted in additional losses to its insureds. Monarch National, as part of its routine business pattern and practices, employs outcome-oriented adjusters/vendors/experts who purposely looked for ways to minimize coverage instead of affording coverage to its policyholders. In contrast to the legislative intent which motivated the enumeration of an insurance adjuster’s responsibilities outlined in the Florida Administrative Code, the insureds were not afforded the professional duties entrusted and imposed on Monarch National by the Public Trust. The outcome-oriented claim adjustment practices undertaken by Monarch National led to Monarch National's failure to adequately adjust the Claim.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Monarch National fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. In order to cure the defects outlined in this Civil Remedy Notice, Monarch National must act as follows: tender policy limits in accordance with Florida VPL; immediately deliver payment of all insurance proceeds due and owing to the insureds which would reasonably place the Subject Property back in its pre-loss condition or, alternatively, if appraisal is or has been requested, complete the appraisal process and deliver payment of the executed award; and keep the claim open for the adjustment of any supplemental claim and payment of any as of yet unincurred costs. If Monarch National disagrees with the extent of the cure requested or asserts that the payment of any of the above cure categories may not be required, Monarch National should cure to the extent it believes it must under the Subject Policy and governing laws to correct the allegations of bad faith contained herein. While it is not being requested as a cure for the bad faith alleged herein, the insureds remain willing to entertain any reasonable counteroffer of settlement.
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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.
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DFS-10-363
Rev. 10/14/2008
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