Civil Remedy Notice of Insurer Violations
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Filing Number:     810692
Filing Accepted:  3/12/2025
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Complainant
Last/Business Name *  
GAI AND TRAN   First Name   LE AND TONY
Street Address * 7142 IVY CROSSING LN
City, State Zip * BOYNTON BEACH, FL 33436
Email Address * TONYVAN1967@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GAI AND TRAN   First Name   LE AND TONY
Policy # * CIT08358329 Claim #* FPI243332
Attorney
Attorney is Applicable
Last Name* ALTMAN First Name * ALEXIS Initial
Street Address* 925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR
City, State Zip* BOCA RATON , FL - FLORIDA 33432
Email Address * AALTMAN@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FLORIDA PENINSULA INSURANCE COMPANY
NAIC Company Code 10132
 
Name of individual responsible for violation (if any):* MARISOL ALVAREZ
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Unsatisfactory Settlement Offer
Claim Denial
* 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)(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.

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.

This notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155, Florida Statutes. Tony Tran and Le Gai (“insured”) purchased an all-risk policy of insurance with Florida Peninsula (“carrier”) to cover their home. The Insured made a claim after suffering damages from Hurricane Ian. The loss was a direct result of a covered peril under the all-risk policy. Although it is clear that the damages are covered, the carrier has not attempted in good faith to settle the insured’s claim 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 their interests. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. 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 insured put the carrier on notice of the damages to their home after a storm. An engineer was sent out. This is a practice of Florida Peninsula to send out engineers who have been paid millions of dollars to write up reports misrepresenting the cause of loss as falling under exclusions under the policy. Specifically, the denial letter attributed the damages to the following exclusions, “the policy does not afford coverage for loss that are caused by wear and tear, chipping, scratches, dents or deterioration. Settling, shrinking, shrinking, bulging or expansion, including resultant cracking of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs or ceilings; Furthermore, the policy does not afford coverage for the following: (g) Animals or insects, including but not limited to, bees, birds, vermin, rodents, marsupials, reptiles, fish, termites, snails, raccoons, opossums, armadillos, flies, bed bugs, lice, ticks, locusts, cockroaches, and fleas.” Pursuant to Florida Statute §624.155(1)(b)(1), Florida Peninsula has failed to settle the claim in good faith when it could and should have done so. The damage to the Insured’s property was clearly caused by a covered peril under the Policy, but Kin has intentionally and wrongfully denied the roof and interior damage, and callously delayed the claim process. Kin has not shown a good faith intention to pay what was owed but rather has underpaid the claim for financial gain and profit. Pursuant to Florida Statute §626.9541(1)(i)(3)(a), Florida Peninsula has a duty to adopt and implement standards for the proper investigation of claims. The field adjuster sent out on behalf of Florida Peninsula displayed a lack of knowledge, improper training, and/or intent to misrepresent damages. Florida law mandates that insurers and adjusters do not mislead the Insured. Florida Insurance companies that fail to follow these Florida laws and regulations, designed to protect consumers, do not only breach their duties under the policy of insurance but do so in bad faith. In violation of Florida Statute §626.9541(1)(i)(3)(b), Florida Peninsula intentionally misrepresented the available coverage under the policy. Florida Peninsula intentionally misrepresented the cause of the damages. Furthermore, the Insured believes Florida Peninsula repeatedly and as a standard business practice engages in this behavior to deprive its Insured of their rightful insurance proceeds when they experience a covered loss. Insured contends Florida Peninsula has implemented a claims program and business practices that are tailored to increase its profits at the expense of benefits that are owed to its customers and that other Insured have been refused insurance proceeds due and owing under the policy in the same or similar circumstances, and some have been provided inadequate insurance monies under the same or similar facts or circumstances. This is wrongful conduct and directly violates the purpose of insurance coverage. Florida Peninsula ’s wrongful conduct and omissions include, but are not limited to: claim delay, not conducting a full and prompt investigation, not treating the policyholder with good faith claims conduct, Florida Peninsula for ways to reduce recovery to Insured; Florida Peninsula for ways to delay full recovery to Insured; holding back and failing to pay portions of claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; and failing to pay the full amount of the Insured’s damage despite knowing it must do so. Consequently, these actions have caused undo frustration and financial harm to the Insured. As a direct and proximate result of the poor handling of this Claim by Florida Peninsula the Insured sustained extracontractual damages. Due to the bad faith actions of Florida Peninsula Insured was forced to engage the services of the Public Adjuster to attempt to recover the settlement to which they are rightfully entitled. 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 regard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. This notice is provided in order to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay all amounts due and owing to the insured in the amount of $128,160.93 for indemnity benefits, minus any applicable deductible or prior payments; and 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. Should you have any questions upon receipt please contact the undersigned at 561-892-9988. Sincerely, Alexis Altman
Comments
User Id Date Added Comment
Mattos@becklawpa.com 05-06-2025 Department of Financial Services Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: Civil Remedy Notice of Insurer Violation Complainant(s) : Le and Tony Gai and Tran Insured(s) : Tony Tran and Le Gai Policy Number : CIT08358329 Claim No. : FPI243332 DFS File Number : 810692 Acceptable Date : March 12, 2025 Insurer : Florida Peninsula Insurance Company To Whom It May Concern: Please be advised that we represent Florida Peninsula Insurance Company (“FPIC”) in the above-referenced matter. Kindly consider this to be FPIC’s report to the Department on the disposition of the alleged violations. FPIC maintains that it has not been in any violation of the law, as alleged by the referenced Civil Remedy Notice (“CRN”) filed by Le and Tony Gai and Tran (the “Insured”). Further, FPIC maintains that the CRN is defective on its face and it fails to comply with the requirements outlined under Florida Statute 624.155. FPIC hereby objects to the Departments acceptance of the above referenced CRN based on the deficiencies. By way of background, this matter involves alleged Water-Roof Leak and damage to the wood due to termites that occurred on or about June 5, 2024. The alleged damage was not reported to FPIC until June 12, 2024. After the report of the alleged damage, FPIC immediately inspected the property on or about June 21, 2024. As a result of that inspection, FPIC determined that there was no storm created openings on the roof system windows or exterior walls and the reported exterior damage to the stucco was related to termites. FPIC further noted that wear and tear, chipping, scratches, dents or deterioration as well as settling, shrinking, shrinking, bulging or expansion, are not covered under the policy. Furthermore, the policy does not afford coverage for the following: (g) Animals or insects, including but not limited to, bees, birds, vermin, rodents, marsupials, reptiles, fish, termites, snails, raccoons, opossums, armadillos, flies, bed bugs, lice, ticks, locusts, cockroaches, and fleas. On or about August 8, 2024 FPIC informed the Insured of the same. In addition, on or about January 31, 2025, Grindley Williams Engineering on behalf of FPIC, performed an inspection of the property. On or about March 11, 2025, FPIC sent additional correspondence to the Insured indicating that the alleged damage was unrelated to any covered peril and there was no wind-related damage observed to the roof covering and was eliminated as a source of moisture infiltration. FPIC further noted in part, that the observed issues on the roof were evidence of thermal expansion and contraction, foot traffic, normal aging, age-related wear, improper installation, and mechanical damage. On March 12, 2025, the Insured, through their legal counsel, filed a CRN against FPIC, which is a pre-requisite to a bad faith lawsuit under Florida Statute 624.155. This CRN alleges that FPIC engaged in “Unfair Trade Practice, Unsatisfactory Settlement Offer and Claim Denial.” Additionally, the CRN alleges that FPIC has violated Florida Administrative Codes and Statutes, including 624.155, F.S.: 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)(d). The CRN requires the Complainant "pursuant to section 624.155, F.S. please indicate all statutory provisions alleged to have been violated." The CRN filed in this matter includes almost every statutory provision that could be claimed, regardless of whether they are relevant or applicable to the alleged facts contained in the CRN. Because the CRN fails to identify any specific statutes, without a shred of factual specificity to support them, FPIC is unable to properly respond and it does not comply with F.S. § 624.155. The CRN further fails to set forth any specific policy language alleged to have been violated in accordance with Florida Statute §624.155(3)(b)(4). The copy of the CRN simply outlines the “loss settlement provision” of the insurance policy. This failure is another reason why it does not comply with F.S. § 624.155. As already mentioned, FPIC maintains this CRN filed by the Insured is defective on its face. Although Florida Statute 624.155 requires the Insured to include requisite factual specificity, this CRN merely contains boilerplate broad language, used routinely in a litany of other filings. In fact, the Insured’s counsel who filed this CRN has filed over 2,000 CRNs in approximately the past 3 years against over 30 different carriers. With regards to the CRN, it contains the same generic improper and legally insufficient allegations that are contained within every CRN filed by the Insured’s legal counsel. The purpose of a CRN is to place the carrier on notice of specific violations so that they can be corrected during the statutory “cure” period. This CRN fails to meet this requirement and as such, should not be able to proceed on such a defective and improper CRN that contains nothing but accusations and conclusions without any specificity. Further, the CRN goes on to allege that the carrier “…has not attempted in good faith to settle the insured’s claim 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 their interests.” These allegations as stated are improper, factually incorrect, do not comply with the specificity requirements set forth in Florida Statute 624.155, and is unfairly vague to put the carrier on notice of any alleged violations. The CRN goes on to allege that the carrier’, “wrongful conduct and omissions include, but are not limited to: claim delay, not conducting a full and prompt investigation, not treating the policyholder with good faith claims conduct, Florida Peninsula for ways to reduce recovery to Insured; Florida Peninsula for ways to delay full recovery to Insured; holding back and failing to pay portions of claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests…” As stated, the facts of this matter clearly show that FPIC acted fairly towards its Insured at all times with regards to this claim. FPIC was notified of the claim on June 12, 2024. An adjuster was assigned to the claim immediately and promptly contacted the Insured to conduct an inspection of the residence on June 21, 2024. Based on the inspection, FPIC determined that there was no storm created openings on the roof system windows or exterior walls and the alleged damage was unrelated to any covered peril and the reported exterior damage to the stucco was related to termites. FPIC further noted that wear and tear, chipping, scratches, dents or deterioration as well as settling, shrinking, shrinking, bulging or expansion, are not covered under the policy. Furthermore, the policy does not afford coverage for the following: (g) Animals or insects, including but not limited to, bees, birds, vermin, rodents, marsupials, reptiles, fish, termites, snails, raccoons, opossums, armadillos, flies, bed bugs, lice, ticks, locusts, cockroaches, and fleas. On or about August 8, 2024 FPIC informed the Insured of the same. In addition, on or about January 31, 2025, Grindley Williams Engineering on behalf of FPIC, performed an inspection of the property. On or about March 11, 2025, FPIC sent additional correspondence to the Insured indicating that the alleged damage was unrelated to any covered peril and there was no wind-related damage observed to the roof covering and was eliminated as a source of moisture infiltration. FPIC further noted in part, that the observed issues on the roof were evidence of thermal expansion and contraction, foot traffic, normal aging, age-related wear, improper installation, and mechanical damage. Therefore, the Insured’s claim that FPIC violated Florida Statutes in this matter is misplaced as FPIC acted fairly towards its Insured and in accordance the terms and conditions of the policy. For these foregoing reasons, FPIC denies all allegations contained in the CRN filed by the Insured, and maintains that the CRN is defective on its face and should be dismissed. The CRN alleges that in order to “cure” the Insured, FPIC “must: 1) Pay all amounts due and owing to the insured in the amount of $128,160.93 for indemnity benefits, minus any applicable deductible or prior payments; and 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made.” FPIC stands by its decision that the number is unreasonable and overinflated to bring the Insured’s property back to its pre-loss condition. The CRN also contains “cures” that are not available under the policy of insurance or under the Civil Remedy Statute. Based on the information outlined above, FPIC requests that the DFS re-consider its acceptance of the above-referenced CRN and further requests that the DFS provide FPIC a list of the guidelines and requirements utilized by the DFS in determining to accept this defective CRN. As outlined above, FPIC maintains that it has not been in violation of any law and that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. Should the Department require additional information, please do not hesitate to contact us. Sincerely, JOSHUA S. BECK, 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