Civil Remedy Notice of Insurer Violations
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Filing Number:     809548
Filing Accepted:  3/4/2025
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Complainant
Last/Business Name *  
EMMA II LLC   First Name  
Street Address * 7523 ALOMA AVE AND 4960 NORTH OAK AVE
City, State Zip * WINTER PARK, FL 32792
Email Address * TODDR112991@AOL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   EMMA II LLC   First Name  
Policy # * 2022-000945-01 Claim #* SDA22041400
Attorney
Attorney is Applicable
Last Name* O'NEIL First Name * JONATHAN Initial
Street Address* 203 FORT WADE ROAD, SUITE 260
City, State Zip* PONTE VEDRA , FLORIDA 32081
Email Address * JONATHAN@WOOLSEYMORCOM.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):* IRMA GARZA AND TIM JONES (FLA. ADJ. LIC. #W164518)
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Other : Wrongful claim denial
Unfair Trade Practice
Other : Unfair claim settlement practices
Other : Unreasonable investigation
Other : Failure to act on claim
Other : Failure to conduct a reasonable investigation based on available information
Other : Failure to maintain proper complaint handling procedures
Other : Misrepresenting the insurance policy provisions to the insured
Other : Misrepresenting Florida statutory provisions to the insured
Other : Misrepresenting facts to the insured
Other : Failure to acknowledge and act promptly upon communications with respect to claims
Other : Denying claims without conducting reasonable investigations based upon available information
* 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)(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.
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.

SMALL COMMERCIAL PROPERTY FORM **** A. Coverages **** We will pay for sudden and accidental direct physical loss of or damage to Covered Property at the locations described in the Declarations caused by or resulting from any Covered Cause of Loss, during the policy period shown in the Declarations. **** 1. Coverage A— Covered Property a. Building, meaning the building or structure described in the Declarations, including: 1) Completed additions; 2) Fixtures, including outdoor fixtures; 3) Permanently installed: a) Machinery; and / or b) Equipment; 4) Hard costs, meaning: a) Foundations, fixtures, attachments and similar property that has become or intended to become a permanent part of the building(s) or structure(s); and / or b) Materials, supplies and similar property owned by others for which you are responsible for. This property must be used in the construction operations insured under this policy and be located at the premise(s) described in the schedule of values. 5) Business Personal Property owned by you that is used to maintain or service the building or structure or its locations, including: a) Fire-extinguishing equipment; b) Floor coverings; and / or c) Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering. 6) If not covered by other insurance: a) Additions under construction, alterations and repairs to the building or structure; and / or b) Materials, equipment, supplies and temporary structures, on or within 1,000 feet of the described locations, used for making additions, alterations or repairs to the building or structure. b. Coverage B – Other Buildings / Structures - Additional Building Property(ies) and / or structure(s) as described on the Declarations. 1) Includes swimming pools, detached garages, sheds, signs, pump houses 2) Includes all fixed outdoor property, and some categories are subject to sublimits. c. Coverage C - Your Business Personal Property consists of the following property located in or on the building(s) or structure(s) described in the Declarations, in the open, or in a vehicle within 1,000 feet of the covered building or structure or within 1,000 feet of the locations described in the Declarations, whichever distance is greater. 1) Furniture and fixtures; 2) Machinery and equipment; 3) Stock; 4) All other Business Personal Property owned by you and used in your business; 5) Labor, materials or services furnished or arranged by you on Business Personal Property of others; 6) Your use interest as tenant in improvements and betterments. Improvements and betterments are fixtures, alterations, installations or additions: a) Made a part of the building or structure you occupy but do not own; and / or b) You acquired or made at your expense but cannot legally remove; 7) Leased Business Personal Property for which you have a contractual responsibility to insure, unless otherwise provided for under Business Personal Property of Others and / or 8) Animals, owned by others and boarded by you, or if owned by you, only as stock while inside of buildings. **** 3. Coverage D - Business Income Coverages. This policy is extended to cover Business Income Coverages and Additional Business Income Coverages for the Actual Loss Sustained by you up to the annual limits shown in the Declarations, during the Period of Interruption directly resulting from a Covered Cause of Loss to Covered Property. **** B. Covered Causes of Loss The Covered Causes of Loss included in this policy means all loss and/or damage arising from the following: 1. Windstorm or Hail which means direct action of wind or direct action of hail, accompanied by wind or not, which causes loss or damage. **** B. Covered Cause of Loss: In addition to the Covered Causes of Loss in the policy, the following Causes of Loss are included: 1. Covered Causes of Loss shall include all other perils, which means all sudden and accidental direct physical loss unless the loss is excluded or limited in this policy. a. All Other Peril excludes collapse. **** C. Additional Coverages 2. Business Personal Property Temporarily in Portable Storage Units 3. Debris Removal a. We will pay your expense to remove debris of Covered Property and other debris that is on the described location(s), when such debris is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of the sudden and accidental direct physical loss or damage. **** 8. Fungus, Mold(s), Mildew, Spores, or Yeast. Associated losses will be covered if you establish that the Fungus, Mold(s), Mildew, Spores, or Yeast is a direct result of a Covered Cause of Loss and this loss is reported within twelve (12) months from the expiration date of the policy. **** 18. Ordinance or Law In the event of sudden and accidental direct physical loss or damage from a Covered Cause of Loss under this policy that results in the enforcement of any law, ordinance, governmental directive or standard in effect at the time of loss or damage regulating the construction, repair or use and occupancy of the property, the following is covered under this policy: a. Coverage A – Coverage for Loss to Undamaged Portion of the Building - For the loss in value of the undamaged portion of the building due to the enforcement of an Ordinance or Law that requires demolition of undamaged parts of the same building. b. Coverage B – Demolition Cost Coverage- For the cost to demolish and clear the site of undamaged parts of the same building, due to the enforcement of an Ordinance or Law that requires demolition of such undamaged property. c. Coverage C - Increased Cost of Construction - For the increased cost of repair or replacement of the damaged and undamaged building on the same or another site, limited to the cost that would have been incurred to comply with the minimum requirements of such Ordinance or Law regulating the repair or reconstruction of the damaged property on the same site. However, there is no coverage for any increased cost of construction loss unless the damaged property is rebuilt or replaced. If the Ordinance or Law requires relocation to another location, the most we will pay for the increased cost of construction is the increased cost of construction at the new location. The increased rebuilding costs must be kept to the minimum needed to satisfy legal requirements. 19. Outdoor Signs, Fences, Antennas, and Vegetation You may extend the insurance provided by this policy to apply to your outdoor signs, fences, radio and television antennas (including satellite dishes), trees, shrubs and plants (other than trees, shrubs or plants which are stock or are part of a vegetated roof), including debris removal expense. Subject to all terms and limitations of coverage, this Additional Coverage includes the expense of removing from the described locations the debris of trees, shrubs and plants which are the property of others, except when you are a tenant and such property is owned by the landlord of the described locations. Outdoor Signs, Fences, Antennas, and Vegetation has a sublimit within Coverage B, Other Buildings and Structures. **** 22. Professional Fees This policy is extended to cover reasonable and necessary Claim Preparation Costs (as defined below) incurred by you at our request to determine the extent or amount of insured loss or damage as a result of a Covered Cause of Loss under this policy, provided that you obtain the prior written approval for the vendor to be engaged. **** We will pay for reasonable costs incurred by you for emergency services taken solely to protect covered property under Coverage A, Coverage B and Coverage C from further damage, as described and covered in Section B. Covered Causes of Loss and SMB 402 1712 CW ALL OTHER PERILS[.] **** Also refer to: Coverage A provision, coverage B provision, coverage C provision, coverage D provision, all additional coverages provisions, all coverages provided by endorsement or rider, the declarations page, loss payment or settlement provision, duties in event of loss policy provision, all terms and conditions of section I of the insurance policy, the insurance policy definitions section, the insurance policy‘s exclusion of coverage provisions, all insurance policy provisions that provide coverage to the insured property, and all policy provisions.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

624.155(1)(a)(1) – violating 626.9541(1)(i) 626.9541(1)(a)(1) -- misrepresenting the terms of an insurance policy. 626.9541(1)(i) -- unfair claim settlement practices. Facts of the case: Underwriters at Lloyd’s, London (Insurers subscribing to Binding Authority B604510568622022: Syndicate 1458 & RenaissanceRe Specialty U.S. LTD) (“UNDERWRITERS”) has committed the following in handling the insured’s claim: 1) failure to pay benefits owed; 2) failure to act in due diligence and good faith to resolve claims; 3) placing the financial interest of the insurer before that of the policy holder and claimant; 4) failure to properly train, evaluate, and manage adjusters retained to represent the policies and procedures of UNDERWRITERS; 5) looking for ways to delay benefit payments and otherwise “low ball” or “stone wall” claims; 6) looking for ways to deny the insured’s claim; 7) looking for ways to reduce recovery to the insured; 8) failure to perform a reasonable investigation; 9) misrepresenting Florida statutory provisions to its insured; 10) misrepresenting insurance policy provisions to the insured; 11) UNDERWRITERS has failed and refused to acknowledge coverage and promptly pay the benefits due and owed to the insured; 12) the reasons for this may be attributed to improper training, supervision, and/or motivation of outside adjusters and claims supervisors to promptly and fairly adjust and pay full benefits available to the insured. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because a proper investigation and full and prompt payment for the loss is not occurring. In Florida, the work of adjusting insurance claims engages the public trust. UNDERWRITERS has breached this duty by its adjustment of the insured’s claim of loss. UNDERWRITERS has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in violations as set forth above. UNDERWRITERS has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages. Despite the insured’s timely notification to UNDERWRITERS of their insurance claim, UNDERWRITERS has failed and refused to acknowledge the covered loss and pay all amounts due and owing to the insured under the policy of insurance. UNDERWRITERS has failed to promptly settle the insured’s insurance claim, when the obligation to settle the claim had become reasonably clear, under one portion of the insurance, in order to influence settlements under other portions of the insurance policy coverage. Despite the insured’s pleas otherwise, UNDERWRITERS has failed and refused to acknowledge its obligation to tender all insurance proceed monies due and owing the insured or assist the insured in mitigation of the damages. In exchange for a premium paid by the insured, UNDERWRITERS issued the subject insurance policy which provided coverage for the insured property from September 19, 2022, through September 19, 2023 for “all sudden and accidental direct physical loss unless the loss is excluded or limited in this policy.” As such, the subject Policy contains coverage for all direct physical losses to the insured property unless the loss is specifically and unambiguously excluded from coverage by the Policy. On or about September 29, 2022, the insured property suffered a windstorm loss (Hurricane Ian), and the insured immediately submitted a claim to UNDERWRITERS for property damage, i.e., storm, wind, rain, and water intrusion damages throughout the insured property. Following the loss, the insured retained RS Builders to perform mitigation repairs, where the insured incurred at least $67,561.94 in temporary repairs. Hence, the insured suffered a substantial loss regarding the real property and continue to suffer such loss. Having suffered such substantial damage, the insured promptly notified UNDERWRITERS of the loss in an effort to mitigate the current damage and prevent the exacerbation of any additional losses. The desired result did not follow. UNDERWRITERS since being presented the Insured’s claim has misrepresented policy provisions to avoid paying the insured what they are owed under the policy. Ultimately, UNDERWRITERS has failed and refused to properly settle the insured’s claim in good faith. The insured have requested that UNDERWRITERS conduct an investigation, admit coverage, and pay damages; UNDERWRITERS has failed and refused to do so. In short, UNDERWRITERS has failed to handle its insured’s claim in good faith in violation of Fla. Stat. 624.155(1)(b)(1), 624.155(1)(b)(3), and 626.9541(1)(i). Based upon UNDERWRITERS’ investigation and property inspection, which confirmed windstorm damages, UNDERWRITERS nevertheless sent correspondence to the insured dated November 30, 2022, (signed by UNDERWRITERS’ adjuster, Irma Garza) and communicated its unequivocal denial of the claim. In regard to insurance contracts, a specific refusal to pay a claim is the breach which triggers the cause of action. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. State Farm Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991) (finding that a breach of contract takes place at the moment the insurance company refuses to pay a claim). Therefore, UNDERWRITERS breached the Policy. Moreover, any argued exclusions and/or limitations to coverage are devoid of anti-concurrent causation language. Thus, “coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause.” Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694, 699 (Fla. 2016). In addition, under the Policy, any ensuing loss to property not excluded or excepted in this policy is covered. Hence, there are a myriad of coverages under the Policy that would provide coverage for the loss. Nevertheless, UNDERWRITERS failed and refused to acknowledge the covered loss and pay all amounts due and owing for the loss. Therefore, UNDERWRITERS breached the Policy. Questioning the propriety of UNDERWRITERS’ coverage denial, and given the extensive nature of the physical damage, the insured retained an expert contractor, Tom Gannon with LSC Construction Consultants, LLC (“LSC”), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on his investigation, Mr. Gannon concluded that a windstorm (Hurricane Ian) on or about September 29, 2022, including wind, caused damage throughout the exterior of the insured property (particularly the roof warranting replacement), which created openings allowing wind and rain to intrude into the interior. Mr. Gannon determined that at least $198,568.37 worth of repairs would be required to return the property to its pre-loss condition as a result of the windstorm loss. Nevertheless, UNDERWRITERS failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, UNDERWRITERS breached the Policy. On March 4, 2025, the insured sent correspondence to UNDERWRITERS enclosing the Sworn Statement in Proof of Loss, the supporting LSC report and mitigation invoice outlining the cause, scope, and cost of the loss, remediation expenses, and other supporting documents, the Notice of Intent to Initiate Litigation, and requested UNDERWRITERS to reconsider its coverage denial. To date, UNDERWRITERS has failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, UNDERWRITERS breached the Policy. As such, UNDERWRITERS’ coverage denial is a blatant misrepresentation of the available coverages under the Policy in direct violation of Fla. Stats. 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is nothing more than a mere pretext to wrongfully deny and delay this claim. As a result, UNDERWRITERS has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of effecting settlement of the insured’s claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Fla. Stat. § 626.9541(1)(i)(2). Further, UNDERWRITERS is in violation of Florida statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Fla. Stat. 626.9541(1)(i)(3)(d) by denying the insured’s claim without conducting a reasonable investigation based upon available information. In summary, the insured’s loss is clearly covered by the terms of the policy of insurance with UNDERWRITERS. However, UNDERWRITERS chose to deny coverage for the insured’s loss. Despite clear evidence that the damages were covered and caused by a covered peril, the claim was denied. To date, UNDERWRITERS continues to deny the insured and its insured full indemnity for the claim. While UNDERWRITERS refuses to honor this claim, a jury in Orange County will likely do what UNDERWRITERS has refused; exercise the benefit of doubt in favor of the insured in finding full coverage for this loss. Indeed, the insured will undoubtedly meet the burden of proof at trial, under the UNDERWRITERS all-risk policy, to show that, while UNDERWRITERS provided insurance coverage, damage occurred to the insured property. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). With the data presented within UNDERWRITERS’ investigation and LSC’s investigation, UNDERWRITERS’ burden to demonstrate by the greater weight of the evidence that all the physical damage to the insured property was caused solely by excluded perils under the policy and not in combination with a covered peril has not and cannot be met. See Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694 (Fla. 2016). Despite clear indicators of covered damage, UNDERWRITERS nevertheless inexplicably denied the insured’s claim. As of today, UNDERWRITERS has failed and refused to inform the insured of their rights under the policy of insurance and Florida statutes, has improperly delayed the insured’s claim, has wrongfully denied the insured’s claim, and has failed and refused to adequately indemnify the insured for the loss and defiantly continues to do so. Indeed, from the time of receiving the claim, UNDERWRITERS has purposely and maliciously delayed in adjusting the subject claim in an effort to either avoid paying the claim altogether or, at the very least, avoid paying the full extent of the loss. Notably, under Florida law, “[t]he filing of a lawsuit does not extinguish the insurer’s obligations under the policy to adjust and pay the claim.” Tristar Lodging, Inc. V. Arch Specialty Ins. Co., 434 F. Supp. 2d 1286, 1289 (M.D. Fla. 2006). To date, the insured have made a good faith effort to comply with all of the requirements under the subject policy of insurance, and it is only fair that UNDERWRITERS do the same. Yet, that is not the case. The insured feel that the insured property is a valuable asset, and, by continuously delaying the proper handling of this claim, UNDERWRITERS is putting the insured property at risk. As responsible property owners, the insured purchased insurance to protect the property, paid all of the premiums, and have kept up to date with the responsibilities under the policy. Yet, when the insured needed to rely on the insurance because of this unforeseen loss, UNDERWRITERS turned its back and delayed and wrongfully denied coverage that the insured are rightfully owed. Ultimately, UNDERWRITERS has failed and refused to properly investigate the loss. The insured have requested that UNDERWRITERS admit coverage and pay damages, UNDERWRITERS has failed and refused to do so, and continues to refuse to fully indemnify the insured for the loss and pay the amounts necessary to properly repair the insured’s property, despite knowing it is required to do so. In short, UNDERWRITERS has failed to handle its insured’s claim in good faith. In Florida, the work of adjusting insurance claims engages the public trust; UNDERWRITERS has breached this duty by its insufficient adjustment of the insured’s claim. UNDERWRITERS has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations set forth above. UNDERWRITERS has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages. 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 upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate their damages to put them back into the position they were prior to loss as quickly as possible. UNDERWRITERS breached this duty. The actions taken by UNDERWRITERS in the handling / adjustment of the insured’s claim were willful, wanton, and with complete disregard for the rights of its insured and occur with such a frequency as to indicate a general business practice and are in violation of Fla. Stat. 624.155 and 626.9541. UNDERWRITERS’ actions amount to but are not limited to the following: 1. Claim delay 2. Wrongful claim denial 3. Unfair trade practice 4. Unfair claim settlement practices 5. Unreasonable investigation 6. Failure to act on claim 7. Failure to conduct a reasonable investigation based on available information 8. Failure to maintain proper complaint handling procedures 9. Misrepresenting the insurance policy provisions to the insured 10. Misrepresenting Florida statutory provisions to the insured 11. Misrepresenting facts to the insured 12. Failure to acknowledge and act promptly upon communications with respect to claims 13. Denying claims without conducting reasonable investigations based upon available information 14. 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. 15. 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. 16. Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 17. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 18. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. Therefore, to cure the defects outlined in this civil remedy notice, UNDERWRITERS must: (1): Admit full coverage for the insured’s loss; and (2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy. A copy of this form submitted to the FDFS has been emailed and/or uploaded and also printed out and mailed to the following parties providing them notice of the filing of this civil remedy notice: Underwriters at Lloyd’s, London (Insurers subscribing to Binding Authority B604510568622022: Syndicate 1458 & RenaissanceRe Specialty U.S. LTD) c/o Leading Edge Claims Service, LLC 1900 L. Don Dodson Drive Bedford, TX 76201 igarza@leadingedgeclaims.com Underwriters at Lloyd’s, London (Insurers subscribing to Binding Authority B604510568622022: Syndicate 1458 & RenaissanceRe Specialty U.S. LTD) c/o Sedgwick Delegated Authority 12650 Ingenuity Drive Orlando, FL 32826 samir.mehta@sedgwick.com
Comments
User Id Date Added Comment
jonathan@woolseymorcom.com 07-09-2025 Withdrawn
ojimenez@wshblaw.com 04-28-2025 Dear Emma II, LLC.: We write on behalf of Velocity Claims, LLC (“Velocity”) who administers claims on behalf of Velocity Specialty Insurance Company ("VSIC”) f/k/a Independent Specialty Insurance Company, and Certain Underwriters at Lloyd's, London ("Underwriters," or, collectively, "Insurers"), which subscribed to Policy No. 2022-000945-01 issued to you, Emma II, LLC (the "Insured"), with effective dates from September 19, 2022 to September 19, 2023 (the "Policy"). The Policy provides coverage for the properties located at 7523 Aloma Avenue & 4960 North Oak Avenue, Winter Park, FL 32792 (the "Property"), subject to its terms, conditions, and exclusions. We understand that the Insured submitted a claim to the Insurers for damages alleged to be the result of Hurricane Ian with a date of loss of September 29, 2022, to which claim number SDA22041400 was assigned (the "Claim"). The Insured filed Civil Remedy Notice No. 809548 on March 4, 2025, and Underwriters provide their response herein. As an initial matter, we note that the Policy includes an Arbitration Clause and Choice of Law provision which provides that all matters in difference shall be referred to an Arbitrational Tribunal. Further, the Arbitration Tribunal shall apply New York Law when resolving all matters in difference between the Parties. To the extent the Insured has any dispute relating to the subject claim, it will need to be resolved via arbitration applying New York Law. As such, the Notice and all Florida statutes and/or law referenced therein would become inapplicable to the subject claim if any differences remain wherein this matter would end up being resolved through the Policy's Arbitration Clause. Although Underwriters contend that Florida law will not apply to any matter in difference for the subject claim, in an abundance of caution they provide their response to the Notice as follows: While Underwriters welcome the opportunity to respond to this Civil Remedy Notice of Insurer Violations and specifically deny each and every allegation contained in the Civil Remedy Notice filed in relation to this claim, Underwriters believe that the Civil Remedy Notice should be deemed deficient as it fails to comply with the specific information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions as set forth in Florida Statute §624.155 and Florida case law. If the Notice is not deemed deficient for the reasons stated below, Underwriters respectfully submit that they have not acted in bad faith. To the contrary, Underwriters have acted at all times in good faith and applied the terms of coverage as clearly and unambiguously as stated in the Policy. THE NOTICE IS LEGALLY DEFICIENT The Notice is legally deficient because it fails to comply with many of the requirements of Section 624.155, Florida Statutes (2022). Since Section 624.155 creates a remedy, it must be strictly construed. See Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. 2010) citing Aetna Cas. & Sur. Co. v. Buck, 594 So.2d 280, 281 (Fla. 1992) and Talat Enterprises, Inc., v. Aetna Cas. & Sur. Co., 753 So.2d 1283–84 (Fla. 2000). First, the Notice in this instance fails to state with specificity the facts and circumstances giving rise to the alleged violations, as required by Section 624.155, Florida Statutes (2022). Moreover, the Notice misrepresents the actual facts of this claim and omits relevant facts that demonstrate how Insurer properly and efficiently adjusted this claim. Section 624.155 mandates that a notice "shall state with specificity . . . the facts and circumstances giving rise to the violation" (emphasis supplied). Additionally, a "civil remedy notice must be specific enough to provide the insurer notice of the wrongdoing so that insurer can cure the same within sixty days." See 624.155, Florida Statutes (2022). Here, the Notice fails to state with specificity the facts and circumstances giving rise to the alleged violation. The Insured alleged twelve (12) separate statutory violations; however, the Insured failed to connect the alleged statutory violations to any facts that support the claim that Insurers violated these statutes. Instead, the Insured generally states violations of these statutes occurred, but provides no specific facts to substantiate these conclusory claims. Rather than explain how Underwriters may have violated these statutes, the Insured simply provides a vague timeline of events which does nothing other than outline the numerous steps Underwriters took to diligently and efficiently investigate the claim. Specifically, the Notice alleges among other things that Underwriters did not attempt in good faith to settle claims; failed to promptly settle claims; made a material misrepresentation to Insured has failed to implement standards for proper investigations; misrepresented pertinent facts relating to coverage; has failed to acknowledge and act promptly upon communications with respect to claims; denied claims with conducting reasonable investigations; failed to affirm or deny full or partial coverage of claims; failed to promptly provide a reasonable explanation on the basis for a denial; failed to promptly notify the insured of any additional information necessary for the processing of the claim; and engaged in unfair claim settlement practices. However, the Insured fails to provide specific instances or information regarding how Underwriters have failed with the same. Also, the Insured failed to establish how Underwriters failed to adjust the claim properly. Contrarily, the Notice itself outlines some of the ways Underwriters properly conducted their investigation. Therefore, the Notice is legally deficient because it fails to state with specificity how Underwriters violated the alleged statutory provisions. Second, civil remedy notices are required to cite to specific policy provisions and specific policy language which has been violated. In this case, the Notice does not do so, rather it merely cites to every potential provision which may provide coverage, without explaining how it was violated or why coverage should have been afforded for same. "The civil remedy notice must reflect a good-faith effort to inform the insurer of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings. Rousso, 2010 WL 7367059 (S.D. Fla. 2010). The civil remedy notice is not the place for posturing or advocacy, and an effort to overstate a claim in a civil remedy notice may end up undermining it." Id. Instead of providing Insurer with facts and instances of the Insured's concerns about the claim, the Notice is essentially a "shotgun-blast effort" to assert Insurer is not complying with the provisions of the Policy and Florida law, though no specific evidence of this has been alleged by the Insured. See, Rousso, 2010 WL 7367059 at 5. This type of approach is disfavored by Florida courts because it is contrary to the purpose of Section 624.155. As a result, Underwriters cannot respond to the alleged violations since the policy provisions listed simply list areas of the Policy without citing to the “specific policy language that is relevant to the violation” as the Notice requires. Accordingly, the Insured's Notice is deficient because they do not state specific provisions or language that is relevant to the alleged violations in a manner to provide Underwriters notice of the alleged wrongdoings, as required by Section 624.155. For these reasons, Underwriters respectfully request that the Notice be deemed deficient and insufficient. Third, the Notice is legally deficient because it fails to provide Underwriters with a reasonable opportunity to “cure” the alleged defects. Section 624.155 mandates that “[n]o action shall lie if, within 60 days after the filing the notice, the damages are paid or the circumstances giving rise to the violation are corrected.” The Florida Legislature enacted the sixty-day cure window to provide a “last opportunity for Safety Specialty to comply with their claim-handling obligations.” 316, Inc v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1192 (N.D. Fla. 2008) (quoting Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d. 1278 (Fla. 2000)). “[T]he purpose of the civil remedy notice is to give the insurer one last chance to settle the claim with its insured and avoid unnecessary bad faith litigation.” 316, Inc., 625 F. Supp. 2d at 1192. Here, the Notice fails to give Underwriters a reasonable opportunity to “cure” the alleged violations. The Notice demands Insurer : "1) admit full coverage for the Insured's loss, and 2) tender all insurance monies due and owing to the Insured for the loss under the Policy". The Notice does not specifically state exactly how much "insurance monies [are] due and owing to the Insured". Additionally, while section 624.155 mandates that “[n]o action shall lie if, within 60 days after the filing the notice, the damages are paid or the circumstances giving rise to the violation are corrected" the Insured has also filed a Notice of Intent to Initiate Litigation, dated March 4, 2025, indicating their intent to initiate litigation within 10 days of the filing of the Notice of Intent. In closing, Underwriters contend that the Civil Remedy Notice should be deemed deficient due to its failure to comply with Florida Statute §624.155 and Florida case law, and regardless of the deficiencies, Underwriters deny all allegations contained in the Civil Remedy Notice and submit there are no violations. Underwriters' investigation of this claim found covered damages to the Property which, although below the Policy's applicable deductibles, were properly accounted for in their estimate for covered damages. UNDERWRITERS ACTED IN GOOD FAITH In the event that the Notice is not considered legally deficient for the reasons stated above, Underwriters deny they have acted in bad faith. To the contrary, Underwriters have acted in good faith and with due consideration of their Insured's interests. Underwriters adjusted the Insured's claim as expeditiously as possible, and in accordance with the terms and conditions of the Policy and Florida law. Moreover, the facts of this claim establish that the Insurer acted in good faith while investigating and adjusting this claim. The Notice is merely a contention that Underwriters acted in "bad faith" because they did not pay what the Insured believed they were owed. This is not "bad faith," and is out of step with the governing law and purpose of Civil Remedy Notice practice. See 316, Inc., 625 F. Supp. 2d at 1194. The property is alleged to have sustained damage on or about September 28, 2022 as a result of Hurricane Ian. After receiving notice of the Insured's claim, Underwriters assigned Sedgwick Delegated Authority (“Sedgwick”), who adjusted the claim under claim number SDA22041400. Sedgwick immediately retained an independent adjuster from AmerAdjust to inspect the property. In accordance with the independent adjuster's inspection, an estimate for the covered damages, which was below deductible for both locations, was drafted and submitted to Insured alongside a letter noting the below deductible valuation. Both the estimate and the letter noting Underwriters' below deductible valuation were submitted to the Insured on November 30, 2022, well with the statutory time frame under section 626.9541(1)(i)(4). Contrary to the allegations contained within the Notice, Underwriters' letter did note the application of various Policy exclusion which "include anti-concurrent causation language". As indicated above, in clear contravention of the Insured's allegations contained within the Notice, Underwriters did not deny the Claim. Underwriters' investigation into the Claim did find certain limited covered damages to the Property and submitted clear and concise correspondence to the Insured noting the same. Additionally, we find it important to note that, contrary to the allegations contained within the Notice, both the RS Builders invoice and LSC estimate for damages, as referenced by the Insured within the Notice, were submitted to Underwriters for the first time on March 4, 2025, the same date as the issuance of the Notice and approximately two and a half years after the date of loss. Although the RS Builder invoice and LSC estimate are alleged to have been drafted in 2022 and 2023 respectively, at no time prior to the issuance of the Notice did the Insured make any attempt to submit these documents to Underwriters. Based on the foregoing, Underwriters adjusted the claim diligently, promptly, and properly. Specifically, Underwriters have not violated statutes 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), 626.9541(i)(3)(h), or 626.9541(1)(i)(4), as alleged in the Notice, because Underwriters promptly sent an independent adjuster to the Property in order to investigate the claim and to determine whether the Property sustained any covered damages associated with the claim. Additionally, Underwriters promptly communicated with the Insured and their representatives throughout the entire investigation of the subject claim. Lastly, Underwriters issued their coverage decision based on the terms, conditions, and exclusions of the Policy. Underwriters specifically deny that they acted in bad faith simply because they have not paid the Insured what the Insured believes it is owed in this claim. To the contrary, Underwriters respectfully submit that they adjusted this claim in accordance with the applicable Policy provisions and the laws of Florida; and have acted in good faith throughout the investigation of this claim. For these reasons, Underwriters respectfully emphasize that they have done nothing other than act in good faith. Underwriters vehemently deny that they have acted in bad faith and denies that they have violated any Florida Statutes, Administrative Codes, or any provisions of the subject policy of insurance. Furthermore, and as noted above, if there are any differences remaining that relate to the subject claim they will need to be resolved via arbitration applying New York Law. As such, all of the law and statutes cited in the Notice will become inapplicable to the subject claim. While this response is meant to be comprehensive, Underwriters, along with Sedgwick Delegated Authority and Velocity Risk, LLC, response above is based upon the limited information provided in the Civil Remedy Notice and the information we have to date. If our insured, Emma II, LLC, feels that we are not in possession of all the facts, please inform us immediately. Please note that Underwriters' response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Underwriters, along with Sedgwick Delegated Authority, Velocity Risk, LLC or any agent or representative of Underwriters, along with Sedgwick Delegated Authority and Velocity Risk, LLC should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Any further action taken by Underwriters, along with Sedgwick Delegated Authority and Velocity Risk, LLC relative to the investigation of this claim should not be construed as a waiver, invalidation, prejudice, or relinquishment of any rights or defenses Underwriters may possess. Nothing contained in this letter or any prior correspondence shall in any way waive your or Underwriters' rights under the Policy. Underwriters will continue to insist upon full and complete compliance with all Policy's terms and conditions. Please understand nothing contained in this letter, or in any prior or subsequent communication on behalf of Underwriters voids, waives, or otherwise modifies any provision set forth in the Policy, and all policy provisions are hereby expressly reserved, as well as all provisions of applicable law without exception or waiver. Additionally, no action taken on the part of Underwriters, along with Sedgwick Delegated Authority and Velocity Risk, LLC, in ascertaining any issues regarding coverage or the amount of loss or damage that may have occurred shall in any way waive, invalidate, or prejudice the rights of Underwriters. For all purposes, Underwriters reserves all rights, claims and defenses to which they may be entitled by virtue of either the Policy or applicable law. Your failure to cooperate in Underwriters' investigation of the above-referenced insurance claim may affect your rights under the Policy. Sincerely, WOOD, SMITH, HENNING & BERMAN LLP By: /s/ Malik Ramelize_________________________ MALIK T. RAMELIZE, ESQ. RICHARD M. SINGER, ESQ.
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