Filing Number: 808716
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| Filing Accepted: 2/27/2025 |
| Last/Business Name
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BONNY
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First Name |
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STEPHAN AND ELIZABETH |
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| Street Address
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188 KENSINGTON WAY |
| City, State Zip
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WEST PALM BEACH,
FL
33414
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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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BONNY |
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First Name |
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STEPHAN AND ELIZABETH |
| Policy # * |
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05448969 |
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Claim #* |
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CH0524426004 |
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Attorney is Applicable
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| Last Name* |
DANIELS
First Name *
MONICA
Initial
E
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| Street Address* |
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560 VILLAGE BOULEVARD, SUITE 110 |
| City, State Zip* |
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WEST PALM BEACH
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FLORIDA
33409
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| Email Address * |
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MDANIELS@THEDANIELS-LAWGROUP.COM |
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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):*
ANDREA COE, RON JENKINS, MONICO AGUILAR, AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE 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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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)(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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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.
SECTION I – PROPERTY COVERAGES
A. Coverage A – Dwelling
1. We cover:
a. The dwelling on the “residence premises" shown in the Declarations, including structures attached to the dwelling; and
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling and Coverage B – Other Structures
1. We insure against direct physical loss to the covered property described in Coverages A and B if that loss is a physical loss to property
6. "Fungi", Wet Or Dry Rot, Yeast Or Bacteria
a. We will pay up to $10,000 for:
(1) The total of all loss payable under
SECTION I - Property Coverages
caused by "fungi", wet or dry rot, yeast or
bacteria;
(2) The cost to remove "fungi", wet or dry rot,
yeast or bacteria from property covered
under SECTION I - Property Coverages;
(3) The cost to tear out and replace any part
of the building or other covered property
as needed to gain access to the "fungi",
wet or dry rot, yeast or bacteria; and
(4) The cost of testing of air or property to
confirm the absence, presence or level
of "fungi", wet or dry rot, yeast or
bacteria; whether performed prior to,
during or after removal, repair,
restoration or replacement.
The cost of such testing will be provided
only to the extent that there is a reason
to believe that there is the presence of
"fungi", wet or dry rot, yeast or bacteria.
SECTION I – CONDITIONS
K. Loss Payment
1. We will adjust all losses with you.
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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.
Stephan Bonny and Elizabeth Bonny (the “Insureds”) purchased an insurance policy from Citizens Property Insurance Corporation/Monarch National Insurance Company (“Insurer”), with Policy number 05448969 (the “Policy”), to cover property located at 188 Kensington Way, West Palm Beach, FL 33414 (the “Property”). On June 7, 2024, a windstorm struck the Property. The excessive winds from this windstorm, which have been measured at 54 mph, caused damage to the Property’s roof, which necessities a full replacement of same. Additionally, repairs are necessary in the following areas in order to bring the Property back to its pre-loss condition: master bedroom and closet, loft, bathroom and shower, stairs, dining room/kitchen and closet, hallway, AC closet, entry/living room, and the garage. The Insureds promptly reported the loss to Insurer and complied with all applicable post-loss obligations. They also retained a public adjuster to guide them through this difficult time.
The Insurer acknowledged the loss and assigned claim number CH0524426004 (the “Claim”) as well as desk adjuster Andrea Coe, field adjuster Ron Jenkins, and engineer Monico Aguilar. The Insurer ultimately inspected the Property to evaluate the loss, and Insurer went on to deny coverage on the Insureds’ claim despite clear indications that the roof sustained wind damage, which led to ensuing interior damages. In its denial, the Insurer claimed that any damage noted to the Property was not from wind, but age-related deterioration, foot traffic and or construction/deficiencies.
The Insureds’ public adjuster provided the Insurer with a true and accurate estimate of the related damages, extensive detailed photographs of the damages, a properly executed sworn proof of loss, a wind report evidencing the 54 mph winds on the reported date of loss, and complied with all of the Insurer’s requests for documentation and information. It is clear that the Insureds have done everything in their power to comply with the Insurer’s requests and all applicable post-loss obligations. The Insurer inspected the Insureds’ Property, and went on to deny coverage on the Insureds’ claim despite clear indications that the Insureds’ damages were caused by a significant windstorm on the date of loss.
Without sufficient funds to repair the property, the Insureds may continue to suffer additional damages. The Insureds were forced to retain legal counsel as it became clear that the Insurer was subverting its obligation to make the Insureds whole. Despite providing all necessary information to the Insurer to make good on its duty to restore the Insureds to their pre-loss condition, Insurer grossly undervalued the claim and ultimately denied a clearly covered claim.
The Insurer’s refusal to properly investigate, adjust, and fully compensate the Insureds for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insureds are entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insureds’ claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3).
The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards denial. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insureds, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insured. The Insurer’s actions amount to, but are not limited to:
A. “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 the insured and with due regard for her or his interests;”
B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”;
C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;”
D. “Failing to adopt and implement standards for the proper investigation of claims;”
E. Claim Delay;
F. Unsatisfactory Settlement Offers; and
G. Unfair Trade Practices.
In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201:
(3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters:
(b) An adjuster shall treat all claimants equally.
2. An adjuster shall adjust all claims strictly in accordance with the insurance contract.
(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
(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 remuneration to himself except that to which he is legally entitled.
(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.
(o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
To summarize, the Insureds are dutiful customers who made it a priority to pay their insurance premiums and to ensure that in such an event as the one here, their property would be covered. The Insureds timely filed a claim and fulfilled all post-loss obligations. Insurer acknowledged the loss, assigned a claim number, and then improperly evaluated the claim. Insurer has failed to provide the Insureds with qualified representatives to ensure the claim was initially adjusted, evaluated, and paid properly. To deny the Insureds the benefit of the bargain after they satisfied all obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations.
In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insured when he most needed the insurance coverage he had paid for.
Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insureds upon demand. The Insurer’s refusal and/or failure to settle the insurance claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insureds’ claim as it is required to do so by contract, in order to influence settlements.
To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty (60) days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insureds, specifically $116,346.03 under Coverage A for Dwelling, which is the amount of the Insures’ estimate for dwelling and mold remediation less applicable deductible; (2) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing for any and all mitigation services performed in connection with the loss; (3) ensure that payment made would be adequate to place the Insureds back in their pre-loss condition, minus all appropriately applicable deductibles; and (4) reimburse the Insureds’ attorney’s fees and costs, since the Insureds were forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insureds, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice, including but not limited to payment of policy limits should the Insureds’ property become structurally unsound as a result of the Insurer’s refusal to adhere to the terms of its own policy. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
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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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