Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 810584

Filing Accepted: 3/11/2025

Print Filing

Complainant

Last/Business Name *

DUNAWAY

First Name

WESLEY

Street Address *

KOVAR LAW GROUP, 111 N. ORANGE AVE., STE. 800

City, State Zip *

ORLANDO, FL 32801

Email Address *

WES@KOVARLAWGROUP.COM

Complainant Type: *

Insured

Last/Business Name*		DERBY		First Name		HARRY
Policy # *		80-44-7852-5		Claim #*		59-59T1-64B

Attorney

Attorney is Applicable

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		STATE FARM FIRE AND CASUALTY COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 25143

Name of individual responsible for violation (if any):* ERIC RODRIGUEZ
Type of Insurance * Residential Property & Casualty

Reason for Notice *

Other : Application of incorrect deductible

* 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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

DEDUCTIBLE. In case of loss under this policy, we will pay, subject to specified policy limits, only that part of the amount of the loss that exceeds the deductible amount shown in the Declarations. Deductibles will be applied per occurrence. Deductibles apply to specific losses as described in this policy.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

I am the duly appointed Personal Representative of the Estate of Harry Derby, deceased (the policy owner). Section 627.7011, Fla Stat. "Homeowners’ policies; offer of replacement cost coverage and law and ordinance coverage" requires insurers to initially pay the actual cash value of insured losses for dwellings and personal property insured on a replacement cost basis, less any applicable deductible. In this case, the insurer applied the hurricane deductible of $3,964.00 to a fire loss. The actual applicable deductible is $2,000.00. Applying a hurricane deductible to a non-hurricane claim is failure to act fairly and honestly. The insurer must cure this violation by paying the difference between the hurricane deductible and the actual applicable deductible ($1,964.00), plus statutory interest.

Comments

User Id		Date Added		Comment
jgroves@conroysimberg.com		03-25-2025		Dear Sir/Madam: This correspondence shall serve as a formal response on behalf of State Farm Florida Insurance Company (hereinafter “State Farm”) to the Civil Remedy Notice of Insurer Violation (hereinafter “Notice”) filed by Wesley Dunaway as personal representative of the Estate of Harry Derby (hereinafter “Insured”). The Notice (Department Filing No.: 810584) was accepted by the Department of Financial Services on 3/11/25. I. The Notice fails to satisfy the requirements of Florida law and should be rejected As to the content of the Notice itself, it is important to note that the Notice is a nullity and should be rejected. The Notice fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, the Notice fails to comply with §624.155(3)(b)(2) and (4), Florida Statutes, which requires that the Notice state, with specificity, the facts and circumstances giving rise to the alleged violation(s), and reference the specific Policy language that is relevant to the violation. Rather than complying with this requirement, the Notice merely utilizes general and vague boilerplate language in an attempt to support various allegations that are factually unsubstantiated and taken together or individually, contradict the violations alleged in the Notice, failing to provide any support for the same. It is of the utmost importance to State Farm that it is provided an opportunity to respond to the concerns of its policyholders. However, the Notice provides nothing more than general statements regarding the rules and regulations governing insurance practice, and a lengthy list of statutes alleged to have been violated, but fails to allege any specific facts that demonstrate the alleged violations complained of by the Insured. The absence of specifics, presented for the first time in the Notice, precludes an appropriate response as provided for in Florida Statute 624.155. As a result, State Farm respectfully requests that the Department reject the Notice based upon the deficiency noted herein. II. Despite the deficiency, State Farm denies all allegations contained in the Notice. Notwithstanding the deficient Notice, State Farm denies it committed any of the alleged wrongful acts or violated the statutes and/or administrative rules cited in the Notice. State Farm hereby denies each and every allegation of wrongdoing contained in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of the Insured's claim. Further, State Farm asserts that none of the allegations complained of by the Insured amount to a violation of any of the Florida Statutes or Administrative Rules cited by the Insured in the Notice. State Farm has acted fairly and with due diligence throughout the handling of the Insured’s claim. To the extent that this reply does not fully address and respond to the allegations set forth by the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations contained therein. FACTS This matter arises out of a claim (Claim No.: 59-59T1-64B) for loss and damage that allegedly occurred at the insured property located at 2731 Carlisle Ave, Orlando, FL 32826 on 11/8/23, as a result of two fires on that date. The claim was reported to State Farm on 11/29/23, under Policy No.: 80-44-7852-5. State Farm has adjusted the claim and paid the undisputed damages owed, along with statutory interest where applicable. State Farm did mistakenly apply the Hurricane Deductible to the above referenced claim for damage caused by fire. However, State Farm has corrected that mistake, and issued payment of the additional amount owed along with statutory interest. REASONS FOR NOTICE State Farm summarily denies each and every allegation of wrongdoing contained within the Notice, and hereby responds to the alleged Reasons for the Notice individually as follows: 1. Application of Incorrect Deductible State Farm does acknowledge that it mistakenly applied the incorrect deductible to the claim. However, State Farm has corrected that mistake and issued payment of the additional amount owed plus statutory interest. Additionally, State Farm denies any allegation that the deductible mistake was done as a result of bad faith. Further, the Notice fails to allege any specific facts or circumstances supporting the Insured’s allegation that State Farm engaged in bad faith by mistakenly applying the incorrect deductible. State Farm has conducted itself according to insurance laws, regulations, standards, and ethics required by the State of Florida, and all actions taken have been in conformity with the Insured’s policy and applicable law. ALLEGED STATUTORY VIOLATIONS The Insured asserts numerous statutory violations pursuant to Fla. Stat. 624.155 against State Farm in the Notice, most of which are typically found in virtually every Civil Remedy Notice of Insurer Violation regardless of the specific facts and circumstances of the individual case. State Farm denies each and every allegation of statutory violation alleged by the Insured in the Notice, and individually as follows: 1. Fla. Stat. §624.155(1)(b)(1): State Farm denies any violation of Fla. Stat. §624.155(1)(b)(1), which provides as follows: 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 towards its insured and with due regard for her or his interests. State Farm has acted fairly and honestly towards its Insured at all times. At no time has State Farm acted dishonestly or unfairly towards its Insured. All of State Farm’s actions have been performed in good faith and for the purpose of moving the Insured’s claim towards a just and proper determination of coverage under the Insured’s policy. State Farm did mistakenly apply the incorrect deductible, but has since corrected that mistake and paid the additional amount owed with interest. Absolutely no facts or circumstances supporting this allegation have been provided by the Insured in the Notice. As a result, there is no evidence that State Farm violated Fla. Stat. §624.155(1)(b)(1), that it did not act in good faith to settle the Insured’s claim, or that it did not act fairly and honestly towards its Insured and with due regard for the Insured’s interests. VIOLATIONS OF POLICY OF INSURANCE The Notice requires the Complainant/Insured to reference the specific policy language that is relevant to the violation, if any. In this regard, the Notice fails to cite to specific policy language and instead only refers to broad sections of the policy. Such constitutes a failure to comply with the Notice requirements. Julien v. United Property & Casualty Insurance Company, 311.So.3d 875 (Fla. 4th DCA 2021). Nevertheless, State Farm specifically denies having violated any portion of the Insured’s policy, including any of its terms, conditions, exceptions, exclusions, endorsements, limitations and coverages of the policy. Further, absolutely no facts or circumstances supporting this allegation have been provided by the Insured in the Notice. FACTUAL AND CIRCUMSTANTIAL SUPPORT FOR THE INSUREDS’ NOTICE The Notice requires the Complainant/Insured to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” The Notice filed by the Insured incorporates vague, unsubstantiated, and boilerplate allegations that provide no specific facts related to the claim and no specific allegations to support the alleged violations. Therefore, this Notice should be dismissed for failure to properly complete the form pursuant to Florida Statute §624.155. Nevertheless, State Farm disputes all wrongful facts alleged by the Insured and denies all allegations of wrongdoing by the Insured. Additionally, State Farm asserts that all actions it has taken in response to the Insured’s claim have been done entirely in good faith and for the purpose of fair, just and timely disposition of the same. CONCLUSION State Farm has adjusted the claim and paid the undisputed damages owed, along with statutory interest where applicable. State Farm did mistakenly apply the Hurricane Deductible to the above referenced claim for damage caused by fire. However, State Farm has corrected that mistake, and issued payment of the additional amount owed along with statutory interest. State Farm has attempted in this correspondence, by and through their undersigned counsel, to fully and adequately respond to the allegations in the Notice. Should the Insured or the Department have any questions regarding this response, please do not hesitate to contact the undersigned. Very truly yours, /s/ Jesse C. Groves Jesse C. Groves

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. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

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