Civil Remedy Notice of Insurer Violations
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Filing Number:     810186
Filing Accepted:  3/7/2025
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Complainant
Last/Business Name *  
NAVARRO   First Name   FREDDY AND ZENAIDA
Street Address * 6792 NW 111TH AVE
City, State Zip * DORAL, FL 33178
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   NAVARRO   First Name   FREDDY AND ZENAIDA
Policy # * 59-CS-U685-3 Claim #* 59-60W5-41H
Attorney
Attorney is Applicable
Last Name* GRICHENER First Name * ULYANA Initial
Street Address* 800 E BROWARD BLVD, SUITE 510
City, State Zip* HOLLYWOOD , FLORIDA 33001
Email Address * UG@WEKLAW.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):* CHRIS COCKE, KELSEY HUTCHINS, GADIEL PENA
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
* 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)(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.

SECTIONS I – LOSSES INSURED 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. However, loss does not include and we will not pay for, any diminution in value. SECTION I – LOSSES NOT INSURED 1. We will not pay for any loss to the property described in Coverage A that consists of, or is directly and immediately caused by, one or more of the perils listed in items a. through m. below, regardless of whether the loss occurs abruptly or gradually, involves isolated or widespread damage, arises from natural or external forces, or occurs as a result of any combination of these: g. wear, tear, decay, marring, scratching, deterioration, inherent vice, latent defect, or mechanical breakdown[.] SECTIONS I – LOSSES INSURED 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. However, loss does not include and we will not pay for, any diminution in value. SECTION I – LOSSES NOT INSURED 3. We will not pay for, under any part of this policy, any loss consisting of one or more of the items below. Further, we will not pay for any loss described in paragraphs 1. and 2. immediately above regardless of whether one or more of the following: (a) directly or indirectly cause, contribute to, or aggravate the loss; or (b) occur before, at the same time, or after the loss or any other cause of the loss: b. defect, weakness, inadequacy, fault, or unsoundness in: (1) planning, zoning, development, surveying, siting; (2) design, specifications, workmanship, construction, grading, compaction; (3) materials used in construction or repair; or (4) maintenance; of any property (including land, structures, or improvements of any kind) whether on or off the residence premises. SECTION I - CONDITIONS 2. Your Duties After Loss. After a loss to which this insurance may apply, you must cooperate with us in the investigation of the claim and also see that the following duties are performed: a. give immediate notice to us or our agent[.] 2. Your Duties After Loss. After a loss to which this insurance may apply, you must cooperate with us in the investigation of the claim and also see that the following duties are performed. 6 e. submit to us, within 60 days after the loss, your signed, sworn proof of loss that sets forth, to the best of your knowledge and belief: (1) the time and cause of loss; (2) interest of the insured and all others in the property involved and all encumbrances on the property. (3) other insurance that may cover the loss; (4) changes in title or occupancy of the property during the term of this policy; (5) specifications of any damaged structure and detailed estimates for repair of the damage; (6) an inventory of damaged or stolen personal property described in 2.c.; (7) receipts for additional living expenses incurred and records supporting the fair rental value loss; and (8) evidence or affidavit supporting a claim under SECTION I – ADDITIONAL COVERAGES, Credit Card, Bank Fund Transfer Card, Forgery, and Counterfeit Money coverage, stating the amount and cause of loss[.] SECTION I - CONDITIONS 6. Suits Against Us. No action will be brought again us unless there has been full compliance with the policy provisions. Any action by any party must be started within five years after the date of loss or damage.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Zenaida Navarro and Freddy Navarro (the "Insureds") purchased an insurance policy ("Policy") from State Farm Florida Insurance Company ("State Farm"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number 59-CS-U685-3 to insure the property located at 6792 NW 111th Ave., Doral Florida 33178 (the "Property"). On or about September 28, 2022, the Property suffered severe damage as the result of Hurricane Ian, which caused damage to the roofing system and ensuing damages to the Property, including but not limited to the interior of the Property (the "Loss"). State Farm was timely notified of the Loss. State Farm acknowledged the claim and assigned claim number 59-60W5-41H ("Claim") to the Loss. The Insureds retained Nationwide Public Adjusters LLC to assist them with the claims process, who inspected as to the damage to the property and provided an estimate of the damages in the amount of $150,329.59. The Insureds retained JD Restorations Inc to mitigate their damages by tarping the roof and performing water mitigation efforts. From the onset, it was clear to the Insureds that State Farm had one goal - to reduce or eliminate its liability in the claim. State Farm delivered a coverage determination that misrepresented the material facts of the claim and relied on a faulty and disingenuous inspection report. State Farm thus denied the Insureds the full benefits they are rightfully entitled to without properly evaluating the proof provided by the Insureds. Frustrated with State Farm’s denial and confused as to their rights under the policy, the Insureds were forced to retain the services of legal counsel. Despite multiple requests from the Insureds pleading that State Farm reconsider their position, State Farm refused to provide the Insureds with the funds needed to return the property to its pre-loss condition. The Insureds have fully complied with all applicable policy provisions requiring cooperation with the investigation, however State Farm is unjustifiably and unreasonably denying payment to the Insureds. Rather than paying the actual damages and/or trying to settle with the Insureds, State Farm is delaying a prompt resolution of the claim. Additionally, State Farm has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder’s interests. As a direct consequence of State Farm’s failure to adjust this loss in good faith and make any payment, the Insureds continue to be without any compensation for the damages sustained at their Property. By stating the above detailed facts, State Farm has 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 Insureds and with due regard for their interest; when State Farm denied coverage on the Insureds’ claim. • 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims, by failing to respond to the Insureds’ public adjuster, and Insureds’ counsel with respect to supplemental requests for payments; • 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. The Insureds property continues to be in disarray as the Insureds are without funds to put their property into its pre-loss condition. As a direct result of State Farm’s denial of coverage and breach of Florida Statutes, the Insureds were forced to seek the help of licensed professionals to assist them. Due to the amount of time that has passed since the date of loss, the information discussed above is irrefutable evidence that State Farm knowingly and intentionally, and in bad faith delays the claims process to further disadvantage the Insureds. The financial detriment caused to the Insureds is a direct result of State Farm’s reckless treatment of the claims process. The Insureds submitted all documents requested in a timely fashion, made their property available for inspection, submitted supplemental invoices, estimates and requests. However, State Farm failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim. To deny the Insureds the benefit clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they have satisfied all their obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the actions complained of, among others, were made by State Farm so often as to constitute a general business practice, evidencing a motive to enhance State Farm’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly shows that State Farm adjusted this claim in bad faith and that State Farm is in direct violation of Unfair Claims Practices. This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should State Farm fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, State Farm must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably compensate the Insureds in order to put the loss property back to its pre-loss condition; (2) Agree to reimburse the Insureds reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be due and owing to the Insureds, relating back to the date of loss.
Comments
User Id Date Added Comment
arudman@simonreedlaw.com 03-21-2025 State Farm denies all of the allegations contained within the CRN filed in this matter which are replete with statements and accusations which are false, inaccurate and without merit. State Farm has acted and continues at all times to act in good faith in the handling of this claim, it wishes to dispel even the inference of a violation and provides herein a response to the CRN setting forth facts which specifically contradict the allegations contained in the CRN and show the CRN is without merit. As an initial matter, CRN sets forth no facts to support that a violation has occurred. The Civil Remedy Statute requires that a civil remedy notice provide the insurer with notice of the circumstances giving rise to the violation so that the insurer has an opportunity to cure any deficiencies during the 60-day cure period. Talat Enterprises Inc. v. Aetna Casualty & Surety Co., 753 So. 2d 1278 (Fla. 2000). The CRN contains conclusory accusations and a set of generic non-claim specific facts applicable to any claim to support them. The CRN is inaccurate, misleading and vague. The CRN contains only general unspecific and unsupported allegations of violations, and deliberately misstates and omits the material facts of this claim of which the Complainants and their representatives are aware and as a result, the notice does not comply with the specificity requirement under the statute. Julien v. United Prop. & Cas. Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). The CRN further fails to cite to any specific policy language relevant to the violations alleged, which is insufficient to put the carrier on notice of the alleged violation. See Demase v. State Farm Florida Ins. Co., 351 So.3d 136 (Fla. 5th DCA 2022) The Complainants’ limited, generic, and vague allegations are all contested. As to the instant CRN, the claim here was reported to State Farm on December 23, 2023 by the Complainants’ public adjuster as a Hurricane Ian loss occurring 450 days prior on September 28, 2022. On the same day as the loss report date, State Farm promptly sent the Complainants a claim acknowledgment letter. On December 28, 2023, State Farm sent a letter to the Complainants, advising that State Farm had been unable to reach them to communicate about the subject loss. On January 8, 2024, State Farm was finally able to communicate with the Complainants’ public adjuster to gather additional facts about the subject loss. On the same day, State Farm sent the Complainants a bill of rights letter and a letter advising of conditions required to be complied with under the subject insurance policy. Additionally, on this day, State Farm sent the Complainants a letter, requesting copies of their written estimate, sworn proof of loss, a list of all vendors and contractors that have visited the property in relation to the subject loss, as well as photographs or videos taken to document the subject loss and the condition of their property immediately following the subject loss. State Farm ultimately received a copy the Complainants’ public adjuster’s estimate, but no sworn proof of loss has been provided to State Farm to date. On January 11, 2024, State Farm sent a copy of the subject policy to the Complainants. On January 13, 2024, State Farm sent the Complainants a reservation of rights letter, as a result of, among other things questions arising about whether the subject loss related to a peril insured against, the date of the subject loss, as well as the late reporting of the same. On January 22, 2024, the Complainants’ public adjuster finally confirmed an in-person inspection date with State Farm to occur at the property on February 1, 2024. On February 1, 2024, State Farm Claim Specialist Gadiel Pena inspected the interior of the property in the presence of one of the Complainants, and spoke to the Complainants’ public adjuster over the telephone as he was not present. As an initial matter, the claimed loss date was confirmed to Mr. Pena. Neither the Complainants nor their public adjuster had knowledge regarding the amount of water involved. Mr. Pena observed yellow water stains in the master bedroom, as well as some paint peeling and drill holes to the ceiling of the master bathroom. On February 2, 2024, Alex Otero from Hancock Claims Consultants inspected the tile roof of the property. Mr. Otero did not discover evidence of wind related damages or sudden loss created damages to the roof. He found evidence of prior repairs, cracked and missing mortar, and foot fall to all roof slopes. Upon completion of its claim investigation, State Farm issued a denial letter to the Complainants on February 22, 2024. The letter advised that the investigation did not reveal any evidence of wind or storm damage to the roof, but rather conditions consistent with age-related wear, tear, and deterioration, foot fall, cracked mortar on multiple end caps and hip lines, and damaged tiles from latent defect, corrosion, design, insufficient workmanship, repairs, and maintenance. As to the interior, the letter advised that the claimed water damage is consistent with multiple weather events and long-term damage, and further advised that it is not possible to attribute the interior damages observed to a single weather event. The letter further referenced the applicable policy language in support of State Farm’s coverage determination. On this same day, State Farm also provided the Complainants and their public adjuster with a letter, advising them of the Complainants’ rights to participate in mediation through the Florida Department of Financial Services. Finally, on June 21, 2024, State Farm received a Property Notice of Intent to Initiate Litigation filed on behalf of the Complainants, which State Farm timely responded to on July 5, 2024 by standing by its coverage determination for the subject claim. In light of the facts stated above, State Farm refutes the baseless accusation contained in the CRN that it is: • 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. 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)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. State Farm strictly denies any violation of any section 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 any section of Florida Statute § 626.9541(1)(i)(3)(d). We believe that the above establishes with clarity that State Farm has at all times acted in the utmost good faith in handling the Complainants’ claim. Notwithstanding the lack of specificity and factual misrepresentations and omissions contained in the CRN, and without waiving any objections to the CRN, or any remedies or defenses available to State Farm because of those deficiencies or otherwise, State Farm denies each allegation of insurer violation or wrongdoing set forth in the CRN. State Farm has complied with the provisions of the subject insurance policy and Florida law in addressing the above referenced claim. If you disagree with any of the assertions State Farm sets forth herein or wish to provide any specific facts and/or records to support your insufficient CRN or the benefits sought by the Complainants, then please provide State Farm with the same.
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