Civil Remedy Notice of Insurer Violations
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Filing Number:     809807
Filing Accepted:  3/6/2025
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Complainant
Last/Business Name *  
SHILLINGFORD   First Name   MAUREEN
Street Address * 9808 LAUREL LEDGE DRIVE
City, State Zip * RIVERVIEW, FL 33569
Email Address * MSHILLINGFORD@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SHILLINGFORD   First Name   MAUREEN
Policy # * 59-QK-2634-8 Claim #* 59-62P7-94B
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* MATTHEW HORN, AMANDA GRANDERSON, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, STATE FARM FLORIDA INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.70131 (1)(a) - Upon an insurer's receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer's claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer. 627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement; 627.4137(1)(e) Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: A copy of the policy. Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

State Farm Florida Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insured; 10) failing to acknowledge and act promptly upon communications with respect to claims; 11) failing to respond to or acknowledge correspondence within statutory time period; 12) failing to provide a loss run statement; and 13) misrepresenting the terms of the insurance policy. On or about April 27, 2023, while the subject policy was in full force and effect, the Insured's suffered a loss caused by wind. The areas impacted include but are not limited to the AREAS. The Insured timely submitted a claim to the Insurer for wind damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 59-62P7-94B to the loss and sent a field adjuster to inspect the property on March 1, 2024. Subsequently, in a coverage determination letter dated March 11, 2024, the Insurer notified the Insured that it was denying coverage for the loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer observed damage to the Insured Property but claimed that it could not determine whether the damage occurred on the reported date of loss and that it was prejudiced in its investigation. The claims determination letter additionally claims the Insured's shingles "are exhibiting wear, tear, and deterioration, commensurate with the age of the roof, along with blistering and granular loss." Initially, the Insurer knows or should know that a denial based on a disputed date of loss is improper when damage did in fact occur from a covered peril within the effective policy period. The Insurer conceded the Insured's roof suffered scattered wind damage but claims not all this damage occurred on the date of loss. It is the Insured's duty to report when damage results from a covered peril and that which occurs within the effective policy period. Correspondingly, the Insurer has an obligation to determine whether a covered peril caused the alleged damages within the policy period irrespective of a disputed date of loss. In other words, the Insured has a right to be compensated for the alleged damages and the Insurer has no right to wrongfully deny coverage. Despite the obvious damage occurring during the effective policy period, the Insurer wrongfully denied the Insured's valid claim. Furthermore, it is unreasonable to suggest the Insurer was somehow prejudiced because of the date Insured reported this loss. Florida law and the policy itself do not require instantaneous notice. Under the policy's duties after loss provision, the Insured is required to provide immediate notice of a loss which any reasonable person would classify reporting a loss after windstorm where the damage was recently discovered, and the condition of the property remained unchanged as immediate. Even if the Insured's date of reporting is somehow considered late notice, Florida law requires the Insurer to demonstrate prejudice stemming from the late reporting. The claims determination letter fails to elucidate how or why it was prejudiced even though the Insurer physically inspected the Insured Property and concluded the damage stemmed from several excluded causes of loss. The Insurer confuses prejudice for its inadequate investigation. The Insurer additionally refused to retain an engineer to determine whether the observed damage stemmed from a covered peril during the policy period. Instead, the Insurer defaulted to deny coverage. Lastly, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. The claims determination letter also failed to comply with Fla. Stat. 626.9541(1)(i)(3)(f) as it did not include a reasonable explanation of the basis in the insurance policy, in relation to the facts, for the denial. Given the denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage, the Insured retained a roofing contractor. After assessing the damage and the true scope of repairs, the roofing contractor prepared an estimate identifying $27,925.77 in covered damage to the roof alone. The foregoing estimate and photographs were sent to the Insurer. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. Furthermore, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On November 15, 2024, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured's representative and have moreover failed or refused to promptly acknowledge the Insured's communications in an attempt to frustrate and delay the resolution of the Insured's claim. In addition, it was not until December 10, 2024, that the Insurer finally responded and said that it had not received the Letter of Representation. This shows that Insurer has failed to acknowledge the receipt of communications within seven (7) days in violation of Florida Statute 627.70131(1)(a). Upon an Insurer's receiving a communication with respect to a claim, the Insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the Insurer which reasonably prevents such acknowledgement. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Failing to provide a loss run statement 12. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: State Farm Florida Insurance Company P. O. Box 106169 Atlanta, GA 30348 statefarmfireclaims@statefarm.com
Comments
User Id Date Added Comment
nsowa@kelleykronenberg.com 03-27-2025 March 27, 2025 Via Electronic Submission Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399 Insured: Maureen Shillingford Insurance Carrier: State Farm Florida Insurance Company Claim No.: 59-62G7-94B Policy No.: 59-QK-2634-8 Date of Loss: April 27, 2023 CRN Filing No.: 809807 CRN Filing Date: March 6, 2025 Property Location: 9808 Laurel Edge Drive, Riverview, FL 33569 To whom it may concern: This is State Farm Florida Insurance Company (“State Farm”) formal response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Maureen Shillingford by attorney Grant Krapf Esq., as it relates to Claim number 59-62G7-94B. The Department of Financial Services (“DFS”) accepted the CRN on March 6, 2025, and assigned it filing number 809807. The following reply has been uploaded to the Department of Financial Services. After reviewing the CRN, State Farm denies all allegation contained in the Insured’s CRN. State Farm conducted a thorough review of its handling of the Insured’s claim, Subject Claim No.: 59-62G7-94B. State Farm denies that it has violated any of the statutes as alleged in the CRN. At all times, State Farm acted in good faith, fairly and honestly toward its Insured and with due regard for the Insureds’ interests. State Farm also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information to allow State Farm to correct the alleged violations. State Farm also contends that the reasons for notice are not proper as State Farm did not engage in any behavior or violate any statues, which are listed in the reason for notice. The CRN requires the Insureds to “indicate all statutory provisions alleged to have been violated," pursuant to section 624.155, F.S. The notice filed by Grant Krapf Esq., in the above-referenced matter includes statutory provisions that could be claimed against an insurance company regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the CRN fails to identify the specific facts applicable to the listed statutes that were allegedly violated with respect to the subject claim, State Farm is unable to properly respond and said CRN should be rejected and returned. Specifically, Insureds allege the following violations of 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 and his interests. State Farm strictly denies any violation of any section of Florida Statute § 624.155(1) (b) (1). • § 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. State Farm strictly denies any violation of any section of Florida Statute § 624.155(1) (b) (3). • § 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. State Farm strictly denies any violation of any section of Florida Statute § 626.9541(1) (i) (2). • § 626.9541(1) (i) (3) (a): Failing to adopt and implement standards for the proper investigation of claims. State Farm strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (a). • § 626.9541(1) (i) (3) (b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. State Farm strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (b). • § 626.9541(1) (i) (3) (c): Failing to acknowledge and act promptly upon communications with respect to claims. State Farm strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (c). • § 626.9541(1) (i) (3) (d): Denying claims without conducting reasonable investigations based upon available information. State Farm strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (d). The Insured also alleges violations of Florida Administrative Code: Insureds further allege the following violations of Florida Statutes: • §627.70131 (1)(a) Insurer’s duty to acknowledge communications regarding claims; investigation (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. State Farm strictly denies any violation of Florida Statute § 627.70131(1)(a). State Farm specifically denies the Insureds’ allegations that State Farm violated the above referenced statutes. • §627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured’s written request, either: A loss run statement. State Farm strictly denies any violation of Florida Statute § 627.444(2)(a). State Farm specifically denies the Insureds’ allegations that State Farm violated the above referenced statutes. • §627.4137(1)(e) Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath , of a corporate officer or the insurer’s claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: a copy of the policy. State Farm strictly denies any violation of Florida Statute § 627.4137(1)(e). State Farm specifically denies the Insureds’ allegations that State Farm violated the above referenced statutes. Also, the CRN fails to set forth any specific policy language alleged to have been violated in accordance with Florida Statute §624.155(3) (b) (4), other than listing a vague recitation of what they believe is the applicable policy language to the alleged violation. It is this failure to identify the specific policy provision(s) that is(are) allegedly relevant to the alleged violation(s) that prevent(s) State Farm from addressing any issues regarding the Subject Claim and Policy. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported, vague, ambiguous, and incorrect allegations with no basis in fact or circumstances. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit and State Farm denies each and every one. Finally, the Notice fails with respect to its requirement to specify how State Farm may “cure” the alleged violations. The purpose of a Civil Remedy Notice is to provide a carrier with one last opportunity to “cure” the alleged violations. In this instance, there is no dollar amount listed for a “cure”. Assuming arguendo, that the real “cure,” sought by the Insured, is payment of all insurance proceeds demanded by the Insured, notwithstanding State Farm’s right to investigate and adjust the loss. The method for curing the violations alleged in a civil remedy notice are not determined by the Insured. Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. Section 624.155(2)(d) would have no effect or purpose under such an interpretation. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). . . . [t]o cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). For the aforementioned reasons, the Civil Remedy Notice is insufficient as a matter of law. State Farm acted in good faith, fairly and honestly toward the Insured in the adjustment of the instant claim. On January 30, 2024, the insured reported a claim in connection with an April 27, 2023, date of loss. As such, the claim was not promptly or immediately reported. On January 30, 2024, the insured allegedly signed a direct pay authorization with red truck roofing with an estimate in the amount of $21,900.00. State Farm acknowledged receipt of the claim. On February 21, 2024, State Farm issued the Homeowners Bill of Rights and temporary repairs letter. On February 22, 2024, State Farm issued correspondence to the insured requesting the insured contact State Farm. On February 23, 2024, State Farm issued its reservation of rights letter. On March 1, 2024, an independent adjuster, Miguel Rosario, inspected the insured property for damages related to the loss. On March 11, 2024, State Farm issued its coverage decision letter wherein it indicated there was no coverage for the claim as there was no damage found to be as the result of the date of loss and that there was wear, tear, deterioration, blistering, and granular loss. Moreover, the letter indicated due to the late reporting, State Farm was prejudiced in its investigation. On March 13, 2024, State Farm issued the Mediation letter to the insureds. State Farm received a request for the policy and provided said policy. Moreover, State Farm advised the insured to contact LexisNexis for the loss run statement and provided the insureds with the information for the request. It is important to note, that while an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. Neither the subject policy nor does Florida law provide that a carrier must accept whatever demand for repairs it is provided by its Insureds as the amount necessary to repair a loss. In the instant case, the violations alleged by the Insured all revolve around the contention that that State Farm did not accept and pay the Insured’s full demand for repair. In closing, State Farm takes the position that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law, and regardless of the rejection, State Farm denies all allegations contained in the CRN and submits there are no violations to the insured. While this response is meant to be comprehensive, State Farm’s response above is based upon the limited information provided in the CRN and the information State Farm has to date. If the Insured, or Grant Krapf Esq., is in possession of information or facts that State Farm is not in possession of, State Farm requests all such information or facts be provided to it immediately. Please note that State Farm’s response is not necessarily exhaustive and does not preclude it from asserting any other valid reason for seeking rejection and return of the CRN. Also, this letter or any act or failure to act on the part of State Farm or any agent or representative of State Farm 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 CRN of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Respectfully submitted, /s/ Christian E. Williams Christian E. Williams, Partner For the Firm
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