Civil Remedy Notice of Insurer Violations
Login

Filing Number:     810652
Filing Accepted:  3/11/2025
         Print Filing
Complainant
Last/Business Name *  
PAWELECK   First Name   JOSEPH
Street Address * 108 COLUMBUS BLVD
City, State Zip * SARASOTA, FL 34242
Email Address * JO@SIESTASUNRISE.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PAWELECK   First Name   JOSEPH
Policy # * 2MR200665401 Claim #* 00201846011
Attorney
Attorney is Applicable
Last Name* MONTAZER First Name * ARDALAN Initial
Street Address* 515 N FLAGLER DR, SUITE 350
City, State Zip* WEST PALM BEACH , FL 33401
Email Address * AM@GMA.LAW
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN SECURITY INSURANCE COMPANY
NAIC Company Code 42978
 
Name of individual responsible for violation (if any):* KATHLEEN FRIEL
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
624.401(1) No person shall act as an insurer, and no insurer or its agents, attorneys, subscribers, or representatives shall directly or indirectly transact insurance, in this state except as authorized by a subsisting certificate of authority issued to the insurer by the office, except as to such transactions as are expressly otherwise provided for in this code.
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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

Dear American Security Insurance Company and Assurant: Please find enclosed the civil remedy notice filed for the above referenced claim. As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the insureds’ claim 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 interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The carrier was put on notice of the insureds’ Hurricane claim. The carrier initially attempted to low-ball the claim. Subsequently, the insureds prepared a loss package in the amount needed to restore the property back to its pre-loss condition. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount only, leaving a remainder to be paid in order to cure the breach, less any applicable policy deductible. The insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. Too many days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insureds’ property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount, less any prior payments and less any applicable policy deductible; 2.) Pay the Insureds’ attorneys’ fees and costs as they have been forced to retain counsel; 3.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. If there are any additional documents and/or outstanding requests and/or information your client and their insurance carriers require, please let us know immediately.
Comments
User Id Date Added Comment
brian.koch@hklaw.com 05-12-2025 VIA UPLOAD onto DFS website Florida Department of Financial Services Division of Insurance Regulation Consumer Assistance / Civil Remedy Section Larson Building, 200 East Gaines Street Tallahassee, Florida 32399-0322 Re: CIVIL REMEDY NOTICE OF INSURER VIOLATION DOI File No.: 810652 Complainant: Joseph Paweleck Claim No.: 00201846011 Filed by: Ardalan Montazer, Esq. Reported DOL: October 9, 2024 Dear Sir or Madam: American Security Insurance Company (“American Security”) received the Civil Remedy Notice of Insurer Violation (“CRN”) submitted by Ardalan Montazer, Esq., on behalf of Joseph Paweleck (the “Complainant”), that was accepted by the Department of Financial Services (the “Department”) on March 11, 2025. The CRN is void as a matter of law as Complainant, through his public adjuster, invoked appraisal on March 11, 2025 at 4:25 P.M., and the CRN was filed at 5:30 PM on the same day - after appraisal had already been invoked. Indeed, pursuant to Fla. Stat. § 624.155(3)(e)(2) “[a] notice required under this subsection may not be filed within 60 days after appraisal is invoked by any party in a residential property insurance claim.” The purpose of the statute is to avoid the very gamesmanship being asserted on behalf of Complainant. Here, the CRN was filed in violation of Florida law. Subject to and without waiver of the foregoing, which renders the CRN a legal nullity on its face, American Security further responds as follows: This matter relates to claim number 00201846011 (the “Claim”) reported under certificate number 2MR07722006654 (the “Certificate”) issued by The Money Source Inc., its successors and/or assigns (the “Lender”) as the “Named Insured” and Complainant as the “Borrower.” The Certificate had an effective period of March 10, 2024 through March 10, 2025 and insured the dwelling located at 108 Columbus Boulevard, Sarasota, Florida 34242 (the “Property”), as more fully set forth therein. As a general matter, American Security objects to the validity of the CRN, as it is deficient on its face. The CRN lacks the specificity required by s. 624.155(3)(a), Florida Statutes. The CRN provides nothing more than vague, ambiguous and conclusory allegations regarding what Complainant believes to be American Security’s motivations, positions and business practices – none of which are true or supported by any facts. Florida law is clear that a claimant is required to state with specificity the “facts and circumstances giving rise to the violation,” to allow the insurer to understand and cure any purported violation. Longpoint Condo. Assn. v. Allstate Ins. Co., 2005 WL 1315810 (N.D. Fla. 2005). A written CRN which is vague and “shotgun” in nature or is written in general terms fails the specificity requirement of the statute. See Heritage Corp. of South Fla. v. National Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294, 1300 (S.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. 2010); Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The very purpose of the civil remedy notice, pursuant to Chapter 624, is to inform the insurer of alleged violations with specific information to encourage settlement of the subject claim. “The sixty-day window [as provided for in F.S. §624.155] is designed to be a cure period that will encourage payment of the underlying claim, and avoid unnecessary bad faith litigation.” Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000). Notice sent to the Department of Insurance concerning settlement violation(s) is intended to serve as a basis for the Department to assist in the settling of claims and to monitor the insurance industry. Id. However, whenever a complainant provides little in the way of adequate notice, the statutory intent of the CRN is frustrated. On October 13, 2024, Complainant reported Hurricane Milton damages to the Property with a reported date of loss of October 9, 2024. American Security acknowledged receipt of the Claim in writing and assigned claim number 00201846011 to the Claim. American Security retained an independent adjuster (“IA”), who inspected the Property on October 18, 2024. The IA discovered wind damages to the Property as well as flood damage to the first level, which is unrelated to the Claim as the Certificate does not cover flood damages. On October 27, 2024, American Security sent an explanation of benefits letter (“EOB Letter”) advising Complainant that it was covering the Claim in accord with its findings and included an itemized estimate exceeding $38,000.00. After offset of the $36,342.00 wind deductible and accounting for depreciation, no payment was made to Complainant. However, American Security advised Complainant that there would be available recoverable depreciation upon the performance of repairs. Subsequently, Complainant made a supplemental claim and, after American Security re-inspected the Property, American Security increased its repair estimates to in excess of $110,000 and tendered payments for $65,410.87 and $5,315.81 to Complainant, as further detailed in the supplemental explanation of benefits letter dated February 5, 2025. Thereafter, Complainant’s representative forwarded a heavily inflated estimate purportedly created by Steadfast Public Adjusters, which estimate exceeds $365,000.00 (“PA Estimate”). For example, such estimate includes nearly $80,000.00 to replace the roof, notwithstanding the fact that Complainant replaced the roof for less than $33,000.00. Indeed, such misrepresentations are in violation of the Conditions of the Certificate and would otherwise bar recovery of insurance proceeds. On March 11, 2025 at 4:25 PM, Complainant, through his public adjuster, invoked appraisal. American Security complied with such request, and the appraisal process is currently ongoing pursuant to the terms of the Certificate, with the most recent inspection taking place on May 2, 2025. The CRN asserts that American Security violated numerous statutory provisions with no specific facts or accurate recitation of circumstances to support these allegations. Without waiver of the legal deficiencies that render the CRN a nullity on its face, American Security denies any and all allegations of bad faith and specifically provides: 624.155(1)(b)(1): Denied. American extended coverage for the Claim and proceeded to appraisal pursuant to the terms of the Certificate at Complainant’s request, and in doing so has always acted fairly and honestly towards the Complainant with due regard for his interests. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 624.155(1)(b)(2): Denied. American Security sent Complainant the EOB Letter and sent Complainant a supplemental explanation of benefits letter dated February 5, 2025. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 624.401(1): Denied. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 626.9541(1)(i)(3)(a): Denied. American Security has adopted and continues to implement standards for the proper investigation of claims. Moreover, American Security has never failed to adopt and implement these standards in such a way that would constitute a business practice. Absolutely no facts or circumstances supporting this allegation have been provided by the Complainant in the CRN. 626.9541(1)(i)(3)(b): Denied. American Security has not misrepresented pertinent facts or insurance policy provisions relating to coverage at issue. Absolutely no facts or circumstances supporting this allegation have been provided by the Complainant in the CRN. 626.9541(1)(i)(3)(c): Denied. American Security had not failed to acknowledge and act promptly upon communications with respect to the Claim. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 626.9541(1)(i)(3)(d): Denied. In fact, American Security did not deny the Claim because it extended coverage for same as evidenced by its EOB Letter dated October 27, 2024 and supplemental explanation of benefits letter dated February 5, 2025. Absolutely no facts or circumstances supporting this allegation have been provided by the Complainant in the CRN. 626.9541(1)(i)(3)(e): Denied. In fact, American Security did not deny the Claim because it extended coverage for same as evidenced by EOB Letter dated October 27, 2024 and supplemental explanation of benefits letter dated February 5, 2025. Absolutely no facts or circumstances supporting this allegation have been provided by the Complainant in the CRN. 626.9541(1)(i)(3)(g): Denied. American Security has not failed to notify Complainant of any additional information necessary for the processing of the Claim. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. American Security denies all the allegations in the CRN as false, unfounded and completely devoid of merit or factual predicate. At no time has American Security ever acted in bad faith. At all times material to this Claim, American Security: (a) Acted in good faith to settle the Claim, acting fairly and honestly in its dealings with the Complainant and his representatives; (b) Promptly investigated the Claim; and (c) Acknowledged and acted promptly in response to all communications with Complainant and his representatives. If you are in need of or seek any further information, please feel free to contact the undersigned. Very truly yours, /s/ Brian H. Koch cc: Joseph S. Menniti, Esq. Ardalan Montazer, 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.

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