Civil Remedy Notice of Insurer Violations
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Filing Number:     810698
Filing Accepted:  3/12/2025
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Complainant
Last/Business Name *  
DANNER   First Name   PAUL, MARYANN AND CHERYL S.
Street Address * 1420 SW 171ST TERR
City, State Zip * PEMBROKE PINES, FL 33027
Email Address * INSURED@MCDONALDBARNHILL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DANNER   First Name   PAUL, MARYANN AND CHERYL S.
Policy # * 79-PD-1371-1 Claim #* 59-59G5-04M
Attorney
Attorney is Applicable
Last Name* GONTRUM First Name * RYAN Initial L
Street Address* 505 S. MAGNOLIA AVENUE
City, State Zip* TAMPA , FL 33606
Email Address * TAL@MCDONALDBARNHILL.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):* KENNETH BUSH AND MIRIAM ARIAS
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.
 
626.9541(1)(i)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
626.9541(1)(i)(3)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED AS FOLLOWS:*** §624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 1. Section 626.9541(1)(i), (o), or (x); §624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 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 towards its insured and with due regard for his interests; 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or 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. §624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: a. Willful, wanton, and malicious; b. In reckless disregard for the rights of any insured; or c. In reckless disregard for the rights of a beneficiary under a life insurance contract; (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. §627.70131 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 14 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 prevent such acknowledgement. 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. (b) As used in this subsection, the term “agent” means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. (c) This subsection shall not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions. (2) Such acknowledgement shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgement reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgement shall provide necessary claim forms, and instructions, including an appropriate telephone number. (3) Unless otherwise provided by the policy of insurance or by law, within 10 working days after an insurer receives proof of loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation. (4) For purposes of this section, the term “insurer” means any residential property insurer. (5) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim unless the failure to pay such claim is caused by factors beyond the control of the insurer which reasonably prevent such payment. Failure to comply with this subsection constitutes a violation of this code. ***Specific policy language that is relevant to the violation*** State Farm Florida Insurance Company (State Farm) failed to adequately adjust and pay the claim covered under the subject insurance policy. Specific policy language relevant to the violation includes, but is not limited to, the Property Coverages, Exclusions, Loss Settlement, and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
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Paul Danner, Maryann Danner and Cheryl S. Danner’s claim results from windstorm which occurred on or about November 16, 2023 to their property at 1420 SW 171st Terr., Pembroke Pines, Florida, 33027. The property was insured under policy number 79-PD-1371-1. The wind from the storm caused damage to the roof of the property, which in turn allowed water to intrude into the property, where it caused damage to the ceilings and walls in multiple rooms. The loss was reported to State Farm Florida Insurance Company (State Farm). State Farm assigned claim Number 59-59G5-04M and named Kenneth Bush as the desk adjuster, and Miriam Arias as the field adjuster for the claim. Ms. Arias performed a perfunctory inspection and prepared an estimate which significantly under scoped the damage to the property. It completely omitted the roof, and otherwise minimized the interior repairs. This estimate totaled just $5,569.21, and was unsurprisingly below the deductible, resulting in State Farm issuing no payment for the loss. The Danners hired Stellar Public Adjusting Services (Stellar) to represent their interests in the claim. Stellar inspected the property and prepared an estimate of the damage totaling $203,759.89. Additionally, the insured hired Y. Rivera and sons to perform a temporary roof repair which totaled $2,000. This invoice, as well as Stellar’s estimate, photos, and other documentation were supplied to State Farm and a request for payment was issued. There is no evidence that State Farm ever considered the documentation provided by Stellar, or did anything further to adjust the loss. Adjusting insurance claims engages the public trust. State Farm has breached this duty in the adjustment of this claim by, failing to treat the insured with good faith claims conduct; failing to adjust, investigate, and evaluate the loss properly; delaying resolution of the claim; failing to consider appropriately produced documentation; not training, supervising, or managing adjusters properly; and placing the company’s financial interests before the welfare of its policyholders. State Farm has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees and representatives which have resulted in some of the statutory violations set forth above. State Farm charged The Danner’s a substantial premium for these coverages but has refused to tender any payment when under all circumstances it could have and should have done so had it acted fairly and honestly. Additionally, it appears this is done companywide. There may be further wrongful conduct and other unknown agents or company representatives which have not been made known to the Insured. Certain conduct or actions cannot be verified without a review of State Farm’s claims file and claim guidelines. Therefore, to cure the defects outlined in this Civil Remedy Notice, State Farm must: 1. Immediately tender all insurance monies due to the Insured for the loss; 2. Act fairly and honestly towards the Insured and with due regard for their interests in attempting to settle the claim; 3. Pay statutory interest on the amount of unpaid contractual damages from the date the claim was reported; 4. Cease and desist all present and future bad faith actions with regard to the Insured’s claim; Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Comments
User Id Date Added Comment
admin@bernstein-chackman.com 04-30-2025 Dear Maryann Paul and Cheryl S. Danner: This letter is to advise you that my firm represents State Farm Florida Insurance Company (hereinafter “State Farm”) in the matter referenced above. This shall serve as State Farm’s response to Civil Remedy Notice number 810698, which was submitted to the Department of Financial Services on behalf of Maryann Paul and Cheryl S. Danner on March 12, 2025. The Civil Remedy Notice states that State Farm violated §624.155 and §626.9541 by doing the following: attempting to settle claims on the basis of an application, failing to adopt standards for proper claim investigation; misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; failing to acknowledge and act promptly upon communications; denying claims without conducting reasonable investigations; failing to affirm or deny full or partial coverage of claims, failing to provide a reasonable explanation for denial of a claim; failing to promptly notify the insured of additional information necessary; failing to clearly explain the nature of the requested information; failing to pay undisputed amounts; and altering or amending an insurance adjuster’s report. State Farm denies all allegations of wrongdoing or violation of Florida Law. State Farm has acted in accordance with Florida law and the subject policy in its handling of this claim. Additionally, the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155. State Farm does not waive any deficiencies in the civil remedy notice with the filing of this response. The Notice neglects to include facts which demonstrate that State Farm violated Florida law, fails to identify the specific policy language that was allegedly violated, or include a reasonable cure for the alleged violations. The purpose of the Civil Remedy Notice is to grant the insurer an opportunity to cure the alleged violations of Florida law. Therefore, complainants must identify the specific policy provisions and statutory language that were violated. In addition, complainants must identify what actions the insurer did that violated such provisions and identify what actions must be taken to cure the violations. As such, Florida Statute §624.155(3)(b) states: The notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: 1. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. 2. The facts and circumstances giving rise to the violation. 3. The name of any individual involved in the violation. 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third-party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In this instance, Civil Remedy Notice 810698 does not include specific facts and circumstances that demonstrate a violation as required by §624.155(3)(b)(2). The notice contains conclusory allegations that State Farm improperly and insufficiently adjusted the claim. As such, the notice fails to comply with §624.155(3)(b)(4). See Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000) & Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The insureds procured policy number 79-PD-1371-1 for the property located at 1420 SW 171st Ter., Pembroke Pines, FL 33027-1431. This claim was reported to State Farm on November 16, 2023, with an alleged date of loss of November 16, 2023. The insured reported a leak in the dining room ceiling near the window. The insured reported no damage to the window and that a contractor, Y. Rivera & Sons Roofing, LLC, repaired the roof for $2,000.00. No water extraction services were completed. State Farm promptly acknowledged the claim by letter dated November 17, 2023. State Farm sent letters to the insureds dated November 19, 2023 explaining the duties after loss under the policy and the right to mediation. State Farm requested an inspection of the property. On November 30, 2023, the property was inspected by field adjuster Kenneth Bush. Kenneth Bush took photographs of the interior of the property and spoke with the insureds. By letter dated December 1, 2023, State Farm explained that the evaluation of the claim was completed the loss did not exceed the policy deductible of $12,010.00. On or about October 28, 2024, the insureds’ public adjuster submitted an estimate in the amount of $167,975.00. The insureds submitted a sworn proof of loss dated September 15, 2024 in the amount of $191,749.89. State Farm requested a second inspection of the property. On December 5, 2024, a roof inspection was performed by Hancock Claims. Field adjuster Miriam Arias conducted the second interior inspection on December 6, 2024. The roof inspection found no wind or hail damage to the roof. There were prior repairs observed as well as mechanical damage and the condition of the roof was consistent with a roof at the end of its useful life. The roof was 22 years old. The roof was original to the property. The insureds had some damage to the roof tiles in 2005. The insureds stated that they had Y. Rivera & Sons perform the roof repair and they did not place a tarp on the roof. By letter dated December 16, 2024, State Farm was explained that on the roof, there was no accidental direct physical loss. The tile roof had evidence of normal wear, tear and cracking for a roof of it’s age, prior repairs, and no storm related damage. Additionally, the damage to the interior of the property was below deductible. In this Civil Remedy Notice the claimants allege that State Farm violated §624.9541(1)(i)(1) by attempting to settle claims on the basis of an application, when serving as a binder or intended to become part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured. However, this is not the case. State Farm promptly acknowledged the claim after it was made on November 16, 2023. State Farm promptly inspected the property on November 30, 2023 and December 5, 2023. On the roof, there was no wind damage and the interior damage was below the deductible. This was explained to the insureds by letter. In this Civil Remedy Notice the claimants allege that State Farm violated §626.9541(1)(i)(3)(a) and §626.9541(1)(i)(3)(d) by failing to adopt and implement standards for proper investigation of claims and by denying claims without conducting reasonable investigations based upon available information. However, State Farm does have standards and promptly acknowledged and investigated the claim. The coverage determination clearly explained the investigation and basis citing the relevant policy language. In this Civil Remedy Notice the claimants allege that State Farm violated §626.9541(1)(i)(3)(b) and §626.9541(1)(i)(3)(c) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue and by failing to acknowledge and act promptly upon communications with respect to claims. However, State Farm did not misrepresent pertinent facts or insurance policy provisions and promptly acknowledged and acted promptly upon communications in this claim. The claim was promptly acknowledged on November 17, 2023. State Farm sent letters to the insureds dated November 19, 2023 explaining the duties after loss under the policy and the right to mediation. State Farm promptly inspected the property and sent a letter to the insureds explaining the basis of the determination and citing to the language within the policy. In this Civil Remedy Notice the claimants allege that State Farm violated §626.9541(1)(i)(3)(e) by 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. However, in this claim, State Farm did not fail to affirm or deny full or partial coverage. State Farm promptly acknowledged the claim and requested an inspection of the property. The coverage determination letter clearly explained the decision based on the investigation and citing to the relevant policy language. In this Civil Remedy Notice the claimants allege that State Farm violated §626.9541(1)(i)(3)(f) by failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. However, State Farm provided a reasonable explanation in writing to the insured. The coverage determination letter provided the basis in the insurance in relation to the facts for the decision. In this Civil Remedy Notice the claimants allege that State Farm violated §626.9541(1)(i)(3)(g) and §626.9541(1)(i)(3)(h) by failing to promptly notify the insured of any additional information necessary for the processing of a claim and by failing to clearly explain the nature of requested information and the reasons why such information is necessary. However, State Farm promptly notified the insureds of its request for inspection and conducted its inspections of the property. The coverage determination letter explained the basis of the decision based on the investigation and policy language. In this Civil Remedy Notice the claimants allege that State Farm violated §626.9541(1)(i)(4) by failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). However, the claim was made on November 16, 2023, and the claim determination was promptly provided. Upon receipt of additional materials, a second inspection was requested and determination promptly provided. The claimants allege that State Farm violated 626.9541(1)(i)(3)(j) by altering or amending an insurance adjuster’s report without providing a detailed explanation as to why any change that has the effect of reducing the estimate was made, including on the report a detailed list of all changes made, and retaining all versions of the report. However, in this case, the interior damage was below the deductible and the estimate was sent to the insured by letter. There was no storm related damage on the roof. State Farm promptly investigated the claim after it was reported, communicated the coverage decisions and policy-based reasons for its claim determination, and advised the insured of their rights and obligations under the policy during the claim investigation. State Farm denies all allegations of non-compliance with Florida law or the subject policy. Furthermore, the civil remedy notice is deficient in that it does not comply with the requirements of Florida Statute §624.155(3)(b). State Farm does not waive any such deficiencies in the filing of this response. Regardless, the accusations raised within the notice are devoid of merit. Thank you for your attention to this matter. If you have any questions, concerns, or wish to discuss this matter, please let me know. Very truly yours, /s/ Michael B. Chackman Michael B Chackman
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