Civil Remedy Notice of Insurer Violations
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Filing Number:     809304
Filing Accepted:  3/3/2025
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Complainant
Last/Business Name *  
RUIZ   First Name   MARCOS
Street Address * 2661 BREAKER LANE
City, State Zip * KISSIMMEE, FL 34746
Email Address * INTAKE2@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   RUIZ   First Name   MARCOS
Policy # * 59-CT-K309-6 Claim #* 59-75H7-66B
Attorney
Attorney is Applicable
Last Name* KADIR First Name * ALI Initial A.
Street Address* 986 DOUGLAS AVE, STE. 102
City, State Zip* ALTAMONTE SPRINGS , FL 32714
Email Address * INTAKE2@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* JEFFREY C. BERTRAND, JEFFREY ROBERTSON, KAYLEE O'BRIEN, AND ALL STATE FARM CLAIMS ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS WHO HANDLED THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Misrepresentation
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

“COVERAGE A – DWELLING We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. . . . COVERAGE B – PERSONAL PROPERTY We will pay for accidental direct physical loss to the property described in Coverage B caused by the following perils, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. . . . . 2. Windstorm or hail.”
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Marcos Ruiz is a homeowner insured with a policy issued by State Farm Florida Insurance Company (“State Farm”). The insured property or home is located at 2661 Breaker Lane, Kissimmee, Florida 34746. In October of 2024, Hurricane Milton caused extensive damage to Mr. Ruiz’s home. Mr. Ruiz timely reported an insurance claim for this damage to State Farm and fully cooperated with all requests for inspections. He provided all requested documentation, if any, and complied with all post loss policy conditions. An estimate for repair of all damages with respect to Mr. Ruiz’s claim was prepared on his behalf for $137,981.30 and was submitted to State Farm. After reporting the claim, State Farm retained an unqualified and biased field adjuster who has a financial relationship with State Farm. This field adjuster inspected Mr. Ruiz’s home in an apparent effort to minimize State Farm’s losses instead of adjusting the claim in good faith in due regard for Mr. Ruiz’s interests. Despite State Farm finding coverage for his claim, it significantly undervalued Mr. Ruiz’s claim at only $2,748.35. Because this amount is less than the subject policy’s deductible, State Farm did not issue any payment to Mr. Ruiz. Due to such, Mr. Ruiz has not been able to permanently repair his home. Indeed, an estimate for repair of all damages with respect to his claim was prepared on behalf of Mr. Ruiz for $137,981.30 and was submitted to State Farm; well above the amount from State Farm. Based on these facts, it is clear State Farm unreasonably denied full coverage for Mr. Ruiz’s claim in bad faith through its extremely low and unreasonable undervaluation of his claim. Had State Farm conducted a reasonable investigation based upon the available information, it would have been evident that affording greater coverage and issuing a substantially higher payment is warranted. Instead, it failed to adopt and implement standards for proper claim investigation as well as misrepresented pertinent policy provisions/facts rather than act fairly and/or honestly with Mr. Ruiz in due regard for his interests. State Farm also delayed the claim and failed to timely respond to communications. This has become a common business practice of State Farm. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. State Farm has breached this duty by refusing to properly and timely adjust the loss. As a result, Mr. Ruiz will have no choice but to retain the undersigned counsel to file a lawsuit against State Farm. State Farm has more than enough information and is still refusing to accept coverage for this claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. State Farm can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Mr. Ruiz based on his $137,981.30 estimate.
Comments
User Id Date Added Comment
dnrobinson@mdwcg.com 04-30-2025 Via Email to Intake2@thekrfirm.com Marcos Ruiz c/o Ali A. Kadir, Esquire 986 Douglas Ave, Ste. 102 Altamonte Springs, Florida 32714 RE: DFS #: 809304 DFS Acceptance Date: March 3, 2025 Complainant: Marcos Ruiz Insured: Marcos Ruiz Insurer: State Farm Florida Insurance Company Policy No.: 59-CT-K309-6 Date of Loss: October 10, 2024 Claim No.: 59-75H7-66B Our File No.: 40977.01246 Dear Mr. Kadir: We have been retained by State Farm Florida Insurance Company (State Farm) to respond to the above-referenced Civil Remedy Notice of Insurer Violation (CRN) filed by you on behalf of Marcos Ruiz (Ruiz). While State Farm welcomes the opportunity to respond to this CRN and specifically denies each and every allegation contained in the CRN filed in relation to this claim, State Farm asserts that the CRN should be rejected as it fails to comply with several of the requirements of the Civil Remedy Notice of Insurer Violation document provisions, as set forth in Florida Statute §624.155 and Florida case law. THE CRN ALLEGATIONS The CRN asserts the following reasons for the notice: • Claim Denial • Claim Delay • Unsatisfactory Settlement Offer • Unfair Trade Practice • Misrepresentation Further, the CRN alleges State Farm violated the following Florida statutes: 624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests. 624.155(1 )(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance poli-cy coverage in order to influence settlements under other portions of the insurance policy coverage. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. 626.9541 (1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provi-sions relating to coverages at issue. 626.9541 (1)(i)(3)(c) Failing to acknowledge and act promptly upon communi-cations with respect to claims. 626.9541 (1)(i)(3)(d) Denying claims without conducting reasonable investiga-tions based upon available information. 626.9541 (1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. 626.9541 (1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. 626.9541 (1)(i)(3)(g) Failing to promptly notify the insured of any additional information nec-essary for the processing of a claim. 626.9541 (1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 626.9541 (1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer re-ceives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless pay-ment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). DISCUSSION For a number of reasons, the CRN fails to comply with the requirements of Florida Statutes. First, the CRN should be rejected because although the CRN identifies several individuals, it also states “all State Farm Claims Adjusters, Employees, Representative, Agents, Vendors, and/or Engineers who handled the claim,” which is vague and ambiguous. The CRN fails to ascribe any specific act of impropriety or statutory violation to the identified individuals or any other specific State Farm employee, representative or agent. It is this failure to ascribe any specific act of impropriety or statutory violation to specific individuals which prohibits State Farm from adequately addressing the issues raised in the CRN and is a reason why the CRN should be rejected. Next, the CRN requires the Complainant “pursuant to Section 624.155, Florida Statutes, please indicate all statutory provisions alleged to have been violated.” As indicated above, the CRN includes statutory provi-sions regardless of whether they are relevant or applicable to any alleged facts contained in the CRN. In fact, based upon the facts of this matter, State Farm performed a prompt investigation of the claim required of it un-der Florida law and the Policy. Further, the facts of this matter evidence that, at all times, State Farm acted in accordance with Florida law and the obligations under its Policy. As will be seen from the factual background of this matter, the allegation of violation of section 626.9541(1)(i)(3)(a) is clearly inapplicable as the present claim was properly investigated and Ruiz was advised of State Farm’s coverage decision within the time frame established by Florida statutes. Therefore, State Farm denies that it violated any of the statutory provisions set forth in the CRN. It is because the CRN contains statutory provisions that are clearly inapplicable, that State Farm is unable to properly respond and the CRN should be rejected. In response to The Department’s request for the “specific policy language that is relevant to the alleged violation”, the CRN merely vaguely references the Coverage A – Dwelling and Coverage B - Personal Property sections for the Policy. There is no indication of how these provisions of the Policy were not complied with and there has been no claim for personal property in this claim. Failing to provide any analysis or discussion of how the policy was violated, or violated the statutory provisions set forth, is in direct contradiction to Florida Statute §624.155(3)(b) and renders the Notice defective. See Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021). Again, it is this failure of the Complainant to comply with the requirements of the Civil Remedy Notice of Insurer Violation document provisions, as set forth in Florida Statute §624.155 and Florida case law, which prohibits State Farm from adequately addressing the issues raised in the CRN and is a reason why the CRN should be rejected. Further, the CRN itself only provides unsupported allegations without setting forth specific facts allegedly evidencing violation of each specific Florida statutes contained in the CRN. Notwithstanding the deficiencies in the CRN, State Farm denies it committed the alleged acts or violated the statutes cited in the CRN and asserts this is another reason why the CRN should be rejected. Additionally, before addressing the allegations set forth in the CRN, the CRN is insufficient on its face. Contrary to the requirements of Section 624.155, Florida Statutes, the CRN does not specifically describe the facts or circumstances giving rise to each statutory violation alleged against State Farm, and as indicated above, many of the alleged statutory violations are clearly inapplicable in light of the allegations contained in the CRN. The CRN simply sets forth the provisions of various statutes and fails to allege any fact or circumstances whereby State Farm’s actions may have violated those statutes. Therefore, the CRN is inadequate under Florida law and must be rejected. Based upon the foregoing, the CRN is insufficient on its face. See, Talat Enterprises Inc., vs. Aetna Cas. & Sur. Company., 753 So. 2d 1278 (Fla. 2000); Lane v. Westfield Ins. Company, 862 So. 2d 744 (Fla. 5th DCA 2003); Valenti v. Unum Life Insurance Company of America, 2006 WL 1627276, 2 (MD Fla. June 6, 2006); Longpointe Condominium Association v. Allstate Ins. Company, 2005 WL 1315810 (MD Fla. June 2, 2005); Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021). Setting forth the correct factual background, State Farm issued insurance policy number policy number 59-CT-K309-6 to Marcos Ruiz, effective May 27, 2024 to May 27, 2025. The policy has relevant limits of $464,400 (Dwelling), $46,440 (Other Structures), $348,300 for Personal Property, and $139,320 for Loss of Use, with a $4,644 Hurricane deductible. On October 10, 2024, the Insured’s property reportedly sustained damage as a result of a Hurricane Mil-ton. On October 13, 2024, the claim was reported to State Farm. It was reported that Hurricane Milton damaged the roof and that there were cracked, broken, slipped and missing tile. On October 14, 2024, State Farm issued the following letters to the Insureds: (1) Acknowledgment and Homeowner Claims Bill of Rights Letter; and (2) Duties under the Policy Letter. Also on October 14, 2024, first contact was made with the insured. Mr. Ruiz reported damage to 24 year old tile roof, bathroom ceiling. On October 15, 2024, a work authorization was received from Augustine Contractors LLC and an Estimate $135,625.96. The roof is a 45.74 square, tile roof. The Augustine Contractors, LLC estimate includes $105,536.96 for the main roof, $14,964.49 for the pan roof, $2,124.22 for gutters and $12,910.28 for solar panels. On October 19, 2024, the inspection was scheduled for October 27, 2024, for Jeffrey Robertson to con-duct. Mr. Robertson did conduct the inspection on October 27, 2024. Mr. Robertson found no wind damage to the tile roof, which was approximately 24 years old. He found wear and tear and deterioration, as well as prior damage from a prior claim from 2018 with another insurance company. Mr. Robertson did find wind damage to the gutters. He prepared an estimate for $393.01 for the repairs to the gutters. This was below the Hurricane deductible of $4,644.00. On November 5, 2024, a partial denial and below deductible letter was sent. As a result, on November 5, 2024, State Farm sent correspondence to Ruiz stating: We have completed our evaluation of your claim and have determined the actual cash value of your loss does not exceed your $ 4,644.00 deductible. Therefore, we are unable to make a payment on your claim at this time. Actual cash value is the replacement cost allowance for reasonable depreciation base on the age and general condition of your property. One of the provisions of your insurance policy is Replacement Cost Coverage. This coverage provides for payment of the actual, necessary cost of making repairs to your dwelling without deduction for depreciation. However, your policy re-quires that repairs be completed before replacement benefits may be claimed. If you obtain an estimate that exceeds the estimate provided, please contact your claim specialist prior to beginning or authorizing repairs. Additionally, based upon the results of our discussions, site inspection, and investigation, it was determined there was no accidental direct physical loss resulting from wind to the roof or exterior of your home other than outlined in our estimate. However, we did observe evidence of wear, tear, and deterioration to portions of the roof and exterior elevations. After receipt of a tarp invoice for $2,355.34, State Farm revised its estimate to include the tarp invoice, for a total of State Farm determined that the policy provided coverage for the reported damage to covered property. State Farm estimated the cost to repair the gutters plus the tarp invoice was $2,748.35, which was still below the deductible of $4,644. Thus, no payment was due. Therefore, based upon the above, State Farm denies it failed to perform a proper, prompt investigation and evaluation of the claim and takes exception with the allegations in the CRN which suggests the contrary. Accordingly, as reflected above, State Farm has acted within the terms of its Policy and Florida Statutes. State Farm asserts there is no basis for the claims made by Ruiz in the CRN that State Farm has failed to act in good faith in the handling of the claim. Likewise there is no basis or factual support for the claims made in the CRN that State Farm improperly delayed the claim; improperly denied the claim; failed to conduct a full and fair investigation of the claim; looked for ways to deny recovery to Ruiz; looked for ways to delay recovery to Ruiz; failed to adjust the claim and failed to evaluate the loss properly, promptly, and fairly so as to provide full and prompt indemnity to the Ruiz; failed to implement proper standards for the adjustment and investigation of insurance claims; or that its actions were willful, wanton and malicious in nature. Further State Farm denies it misrepresented the insurance policy provisions to the insured; misrepresenting Florida statutory provisions to the insured; or misrepresented any facts to the insured. In closing, State Farm first requests the CRN be rejected due to its failure to comply with Florida Statute §624.155 and Florida case law. Regardless of the rejection, as demonstrated above, State Farm has, at all times, acted in good faith, with due diligence, and in accordance with the terms of its insurance policy and Florida Statutes with respect to the handling of Ruiz’s claim. State Farm denies the allegations contained in the CRN. We trust this response adequately addresses the allegations of violation alleged in the CRN. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the under-signed. Very truly yours, Danielle N. Robinson Danielle N. Robinson
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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DFS-10-363
Rev. 10/14/2008