Civil Remedy Notice of Insurer Violations
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Filing Number:     810781
Filing Accepted:  3/12/2025
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Complainant
Last/Business Name *  
THOMAS   First Name   ANNE AND MARCUS
Street Address * 1452 ALHAMBRA DR.
City, State Zip * FORT MYERS, FL 33901
Email Address * LITIGATION@THEFREEMANLAWFIRMPA.COM
Complainant Type: * Insured
Insured
Last/Business Name*   THOMAS   First Name   ANNE AND MARCUS
Policy # * AL91-007376-00 Claim #* SWYCSHO00775
Attorney
Attorney is Applicable
Last Name* FREEMAN First Name * BRIAN Initial
Street Address* 4245 FOWLER STREET
City, State Zip* FORT MYERS , FLORIDA 33901
Email Address * LITIGATION@THEFREEMANLAWFIRMPA.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   CLEAR BLUE SPECIALTY INSURANCE COMPANY
NAIC Company Code 37745
 
Name of individual responsible for violation (if any):* KRISTEN WILLIAMS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Bad Faith
* 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.
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.
* Specific policy language that is relevant to the violation.
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The Insureds are in possession of a copy of their insurance policy and believe their insurance policy language relevant to the violations includes all applicable insurance policy coverages, loss payment provisions, valuation provisions and other terms and conditions of Insurance Policy No. AL91-007376-00. In particular, the Insureds refers to the following insurance policy coverages included in their insurance policy: SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". 2. We do not cover land, including land on which the dwelling is located. B. Coverage B – Other Structures 1. We cover other structures on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. 2. We do not cover: a. Land, including land on which the other structures are located; b. Other structures rented or held for rental to any person not a tenant of the dwelling, unless used solely as a private garage; c. Other structures from which any "business" is conducted; or d. Other structures used to store "business" property. However, we do cover a structure that contains "business" property solely owned by an "insured" or a tenant of the dwelling, provided that "business" property does not include gaseous or liquid fuel, other than fuel in a permanently installed fuel tank of a vehicle or craft parked or stored in the structure. 3. The limit of liability for this coverage will not be more than 10% of the limit of liability that applies to Coverage A. Use of this coverage does not reduce the Coverage A limit of liability. J. Loss Payment We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable 60 days after we receive your proof of loss and: 1. Reach an agreement with you; 2. There is an entry of a final judgment; or 3. There is a filing of an appraisal award with us. D. Loss Settlement In this Condition D., the terms "cost to repair or replace" and "replacement cost" do not include the increased costs incurred to comply with the enforcement of any ordinance or law, except to the extent that coverage for these increased costs is provided in E.11. Ordinance Or Law under Section I – Property Coverages. Covered property losses are settled as follows: 1. Property of the following types: a. Personal property; b. Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings; c. Structures that are not buildings; and d. Grave markers, including mausoleums; at actual cash value at the time of loss but not more than the amount required to repair or replace. 2. Buildings covered under Coverage A or B at replacement cost without deduction for depreciation, subject to the following: a. If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, without deduction for depreciation, but not more than the least of the following amounts: (1) The limit of liability under this policy that applies to the building; (2) The replacement cost of that part of the building damaged with material of like kind and quality and for like use; or (3) The necessary amount actually spent to repair or replace the damaged building. If the building is rebuilt at a new premises, the cost described in (2) above is limited to the cost which would have been incurred if the building had been built at the original premises. b. If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the building: (1) The actual cash value of that part of the building damaged; or (2) That proportion of the cost to repair or replace, without deduction for depreciation, that part of the building damaged, which the total amount of insurance in this policy on the damaged building bears to 80% of the replacement cost of the building. c. To determine the amount of insurance required to equal 80% of the full replacement cost of the building immediately before the loss, do not include the value of: (1) Excavations, footings, foundations, piers, or any other structures or devices that support all or part of the building, which are below the undersurface of the lowest basement floor; (2) Those supports described in (1) above which are below the surface of the ground inside the foundation walls, if there is no basement; and (3) Underground flues, pipes, wiring and drains. d. We will pay no more than the actual cash value of the damage until actual repair or replacement is complete. Once actual repair or replacement is complete, we will settle the loss as noted in 2.a. and b. above. However, if the cost to repair or replace the damage is both: (1) Less than 5% of the amount of insurance in this policy on the building; and (2) Less than $2,500; we will settle the loss as noted in 2.a. and b. above whether or not actual repair or replacement is complete. e. You may disregard the replacement cost loss settlement provisions and make claim under this policy for loss to buildings on an actual cash value basis. You may then make claim for any additional liability according to the provisions of this Condition D. Loss Settlement, provided you notify us, within 180 days after the date of loss, of your intent to repair or replace the damaged building.
 
* Facts and circumstances giving rise to the violation.
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During the policy period, on September 28, 2022, the Insureds’ home located at 1452 Alhambra Dr. Fort Myers, FL 33901, owned by Anne and Marcus Thomas ("Insureds"), suffered hurricane/windstorm related physical and structural damage as a direct result of Hurricane Ian, a covered loss under the subject insurance policy. Please see insurance policy language above that indicates insurance coverage for hurricane/windstorm damage to the Insureds’ home and roof system as a direct result of Hurricane Ian. Subsequent to Hurricane Ian, the Insureds immediately reported the loss to their insurance carrier, Clear Blue Specialty Insurance Company, ("Insurer"). Since the beginning of the claims process, the Insureds fully cooperated in the Insurer's investigation of the Insureds’ hurricane/windstorm damage claim. Despite overwhelming evidence the Insureds’ home and roof system had been significantly physically and structurally damaged by Hurricane Ian, all covered losses under the subject insurance policy; the Insurer unreasonably and improperly investigated, inspected, evaluated, adjusted and failed to pay the correct amount of damage to the Insureds’ home and roof system. The Insurer performed a completely inadequate investigation of the damage to the Insureds’ home and roof system. The Insurer retained EFI Global (“EFI”), a financially biased engineering firm, to inspect the Insureds’ hurricane/windstorm damage. EFI confirmed hurricane/windstorm damage to the Insureds’ roof system and windows. However, EFI opined the damage did not necessitate a full roof system replacement. On February 1, 2023, the Insurer sent correspondence to the Insureds informing the Insureds their hurricane/windstorm damage claim was partially denied. The Insurer determined a total of only $7,817.28 was owed to the Insureds on the Insureds’ Hurricane Ian damage claim. After deducting “depreciation” and the deductible, payment of a mere $836.78 was made on the Insureds’ Hurricane Ian damage claim by the Insurer. The Insureds retained, at their own expense, Dave Griffey, (“Mr. Griffey”), of Day Adjusting and Consulting, to inspect their home and roof system for hurricane/windstorm damage. During his inspection, Mr. Griffey documented extensive physical and structural hurricane/windstorm damage to the Insureds’ roof system, exterior damage, interior damage and damage to the Insureds’ windows. As a result of Mr. Griffey’s inspection, Mr. Griffey provided the Insureds with a damage estimate in the sum of $115,016.40. On March 24, 2024 the Insureds invoked Appraisal pursuant to the terms of their insurance policy with the Insurer. After the parties’ appraisers could not reach an agreement on the claim or mutually agree to an Umpire, the Insurer filed a Petition for Declaratory Relief in Lee County requesting the Court appoint an Umpire. The Insurer did not extend coverage for the clearly evident Hurricane Ian damage to the Insureds’ home as a direct result of Hurricane Ian as set forth in Mr. Griffey’s damage estimate. The Insurer failed to extend full coverage for the Insureds’ clearly evident hurricane/windstorm damage, indicating the Insurer does not have proper standards for investigating the proper scope and amount of damage caused by a covered loss. The Insureds provided all the evidence necessary supporting the actual costs associated with the complete replacement of their roof system and the amount necessary to repair the interior and exterior damage to their home in order to restore their home to its pre-loss condition. However, despite this evidence and information, the Insurer failed and refused to pay for the Insureds’ damage in order to restore their home to its pre-loss condition. Moreover, the Insurer did not perform a legally sufficient hurricane/windstorm damage investigation by failing to perform a substantial structural damage investigation and determination as required by The Florida Building Code and failing to retain a licensed Florida Professional Engineer to investigate the full extent of physical and structural damage to the Insureds’ home a direct result of Hurricane Ian. The Insurers failure to perform this very important substantial structural damage determination and failure to retain a licensed Florida Professional Engineer to assist the Insurer in its investigation of the Insureds’ hurricane/windstorm damage claim further indicates the Insurer did not comply with the basic requirements inherent in the proper investigation of hurricane/windstorm damage claims, and instead performs inadequate and incomplete investigations in order to improperly partially deny valid claims. The Insureds provided the Insurer with an overwhelming amount of evidence to support the extensive physical and structural damage to their home and roof system and other Hurricane Ian related damage to their home and a comprehensive damage estimate from Mr. Griffey. Notwithstanding, the Insurer failed and refused to pay the amount necessary to restore their home to its pre-loss condition. The work of adjusting insurance claims in Florida engages the public trust. In the instant case, the Insurer breached this duty through its complete failure to properly investigate, inspect, evaluate, adjust and pay the hurricane/windstorm damage claim of the Insureds. The Insurer's failure to properly inspect, investigate, evaluate, adjust and pay for the damage to the Insureds’ home and roof system, failure to communicate with the Insureds, and improper handling of the Insureds’ hurricane/windstorm damage claim clearly indicates the Insurer failed to adopt and implement proper standards for the investigation, evaluation and adjustment of claims; failed to properly train, manage, supervise and promote claims adjusters so Insureds, such as the Insureds in this case, receive good faith, fair and prompt adjustment of claims; and failed to conduct a full and fair investigation of this hurricane/windstorm damage claim. The Insurer furthermore failed to provide full reasons and facts to the Insureds for the partial denial of their hurricane/windstorm damage claim resulting in the statutory violations as set forth in this notice. The Insurer also breached its duty to the Insureds by failing to timely and promptly pay the correct indemnity owed to its Insureds. This duty is owed by the Insurer to its Insureds and is inherent in the insurance claims process. The Insureds promptly provided all the necessary documentation, evidence and information for a timely resolution of their hurricane/windstorm damage claim, including an itemized damage estimate from Mr. Griffey and extensive documentation of the damage to their home as a direct result of Hurricane Ian to the Insurer which clearly shows the damage to the Insureds’ home exceeds the grossly inadequate undisputed amount of damage the Insurer documented to the Insureds’ home. To date, the Insurer failed to provide timely and prompt payment for the correct amount of the Insureds’ damage. To date, the Insureds performed all conditions precedent required of them undertheir insurance policy with the Insurer and under Florida law. However, the Insurer and its agents failed and refused to properly investigate, inspect, evaluate, adjust and pay the Insureds’ hurricane/windstorm damage claim and failed to tender all insurance proceeds due and owing to the Insureds under the subject insurance policy. Due to the Insurer's intentional delay and insufficient investigation of the Insureds’ hurricane/windstorm damage claim, the Insureds were forced to obtain legal counsel at a significant cost and expense to attempt to recover what they are legally owed under their insurance policy with the Insurer. The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that an Insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Simply put, the Insurer failed to comply with its duty to indemnify the Insureds and breached the insurance policy. The Insurer failed and refused to properly investigate, inspect, evaluate, adjust and pay the Insureds’ hurricane/windstorm damage claim. The Insurer failed and refused to pay the correct amount of insurance proceeds to date owed to the Insureds as required by the insurance policy and Florida law. Refusal and failure to pay the Insureds’ hurricane/windstorm damage claim, when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insureds is a breach of the insurance policy and a violation of Florida Law. The actions taken by the Insurer in the handling and adjustment of the Insureds’ hurricane/windstorm damage claim were willful, wanton, and in disregard for the rights of its Insureds and occur with such a frequency as to indicate a general unfair and deceptive business practice in violation of Florida Statutes § 624.155 and § 626.9541. Based on the foregoing actions and omissions, the Insurer engaged in wrongful claims handling conduct, including but not limited to, the following: 1) Improper partial claim denial; 2) Improper claim delays; 3) Not conducting a full and fair investigation of the Insureds’ hurricane/windstorm damage claim; 4) Looking for ways to deny recovery to the Insureds; 5) Overlooking covered damages to the Insureds’ home and roof system; 6) Failing to pay the necessary amounts due and owing to restore the Insureds’ home to its pre-loss condition; 7) Not adjusting the claim and not evaluating the loss properly, promptly and fairly so as to provide full and prompt indemnity to its Insureds; 8) Failing to implement proper standards for the adjustment and investigation of insurance claims; 9) Failing to pay the requisite monies owed for the Insureds’ loss, despite receipt of a detailed damage estimate from Mr. Griffey and supporting documentation; 10) Not training, supervising or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed; 11) Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses. The Insurer violated the statutes set forth above based on the conduct described herein. The Insurer failed and refused to tender insurance proceeds required by its insurance policy with its Insureds. In addition, the Insurer failed to reasonably and properly pay and resolve the Insureds’ hurricane/windstorm damage claim for money damages when under all the facts and circumstances, it could have and should have done so if it had acted fairly and honestly towards its Insureds. The Insurer’s improper actions are well documented and have occurred with such frequency as to constitute a general unfair and deceptive business practice and were made in a reckless disregard for its Insureds’ rights. The Insurer placed its interest above and before the Insureds’ interest in this matter. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must do the following: A. Immediately pay the Insureds’ hurricane/windstorm damage claim in the amount of Mr. Griffey’s damage estimate of $115,016.40, plus interest, less the applicable deductible and prior undisputed pyment. B. Agree to tender any recoverable depreciation once it has been incurred per the terms of the insurance policy.
Comments
User Id Date Added Comment
kferry@camboferry.com 05-08-2025 Katelyn Ferry Partner Direct: 508.728.6623 kferry@camboferry.com Erick Rodriguez Senior Associate Attorney Direct: 954.296.3820 erodriguez@camboferry.com May 8, 2025 VIA E-MAIL AND FILED ELECTRONICALLY DFS PORTAL AND TO COUNSEL Florida Department of Financial Services Bureau of Consumer Assistance – Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Brian Freeman litigation@thefreemanlawfirmpa.com Re: Civil Remedy Notice Response DFS Filing No.: 810781 Filing Date.: March 12, 2025 Claim No.: SWYCSHO00775 Policy No.: AL91-007376-00 DOL: September 28, 2022 To Whom It May Concern: This correspondence constitutes Clear Blue Specialty Insurance Company’s (“Clear Blue”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Anne and Marcus Thomas. The CRN bears filing number 810781 and was accepted by the Florida Department of Financial Services on March 12, 2025. Clear Blue has carefully reviewed the allegations contained in the CRN and denies all allegations of statutory violations, claim mishandling, or bad faith conduct. The insurance policy is a contract between the Insurer and the Insureds. There are terms, conditions, limitations and exclusions contained in the policy. Application of the policy is subject to said terms, conditions, exclusions and limitations. “Although the term ‘all risk’ is afforded a broad, comprehensive meaning, an ‘all risk’ policy is not an all loss policy and thus does not extend coverage for every conceivable loss.” Fayad v. Claredon Nat. Ins. Co., 899 So. 2d 1082, 108 (Fla. 2005). Clear Blue hereby preserves its right to raise Complainants’ fallacies in any prospective lawsuit brought by Complainants in accordance with applicable Florida law. See Bay v. United Servs. Auto. Ass’n, 305 So. 3d 294, 299-300 (Fla. 4th DCA 2020). OVERVIEW – COMPLAINANTS’ NOTICE IS INACCURATE AND LACKS MERIT As to the content of the Notice, 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 as discussed in further detail below. Clear Blue would further state that Complainants’ CRN is defective as it fails to comply with the strict governing requirements contained within Florida Statute § 624.155. Namely, the statute requires that a CRN shall “state with specificity . . . [t]he facts and circumstances giving rise to the violation.” Fla. Stat. § 624.155(3)(b). Under Florida law, a Civil Remedy Notice must state the facts and circumstances that give rise to an alleged violation with such specificity sufficient to allow an insurer to cure any alleged violation within the 60-day statutory period. See Lane v. Westfield Insurance Company, 862 So.2d 774 (Fla. 5th DCA 2003). Complainants’ CRN is rife with deficiencies as the limited facts and circumstances set forth therein are false, incomplete, misleading, and insufficient to establish a violation of any statute or policy provision. Additionally, the CRN includes a list of nine (9) statutory provisions alleged to have been violated. The referenced statutes and code sections, however, do not appear to be pertinent to the subject claim, and the CRN fails to specify each statute’s relative applicability to same. Thus, the statutory references are a nullity. Further, the CRN does not contain specific facts addressing and supporting each alleged statutory violation against Clear Blue, but rather sets forth only stock, conclusory allegations of purported bad faith that merely restate the language of the statute. For these reasons alone, the CRN is defective on its face. Moreover, the CRN does not list the Complainant’s e-mail address instead it provides the email of counsel. See Pin-Pon Corp., 2020 U.S. Dist. LEXIS 100072, *7 (S.D. Fla., June 5, 2020). Clear Blue Insurance explicitly denies violation of any applicable Florida Statutes in the adjustment of the referenced claim and further denies that it has not attempted in good faith to settle the Insureds’ claim when under all the circumstances it could and should have done so, and it denies that it has failed to act fairly and honestly toward its Insureds’ interests. ALLEGED REASON FOR NOTICE Claim Denial: There is no basis for this allegation, thus it is denied. Complainants submit no facts or circumstances to support this allegation and merely provide boilerplate restatements of statutory language. The record reflects that Clear Blue did not deny the claim but instead issued undisputed payment in the amount of $836.78 on February 1, 2023, following a prompt inspection and detailed estimate. Further review was initiated upon receipt of a $105,816.61 PA estimate, and an engineer was assigned to determine causation and scope of claimed damages. Clear Blue has not denied the claim but has properly participated in the appraisal process after DFS mediation reached impasse. At no time did Clear Blue or its representatives act dishonestly or unfairly toward the Insureds. The investigation was conducted in good faith and in compliance with Florida law and the terms of the policy. Therefore, the allegation of claim denial is factually and legally without merit. Unsatisfactory Settlement Offer: There is no basis for this allegation, thus it is denied. Complainants provide no supporting facts or documentation to substantiate this claim. Clear Blue issued its undisputed payment shortly after its inspection. Thereafter, Clear Blue requested a Sworn Proof of Loss and supporting documentation to evaluate the Insureds’ supplemental claim, including a substantially inflated PA estimate. Clear Blue retained an engineer, issued a Reservation of Rights, and maintained open communication throughout the adjustment period. Further, the parties have been actively participating in appraisal as a means of alternative dispute resolution. Clear Blue’s communications consistently referenced relevant policy provisions, including the Roofing Materials Payment Schedule endorsement and Loss Settlement provisions. Clear Blue proceeded in accordance with the policy and Florida law, and at no time made an "unsatisfactory" settlement offer—because the amount paid was based on the agreed, undisputed scope. The disputed damages proceeded to mediation and later to appraisal. Therefore, this allegation is baseless and inconsistent with the documented claim history. Unfair Trade Practice: There is no basis for this allegation, thus it is denied. Complainants fail to provide any facts, examples, or conduct to support a claim that Clear Blue engaged in an unfair trade practice. The Notice contains no specific references to what conduct is alleged to constitute such a practice, nor does the claim history reflect any action that would support such a charge. On the contrary, Clear Blue responded promptly to the FNOL, conducted an inspection on December 28, 2022, issued payment in February 2023, and maintained an open line of communication with the Insureds and their representatives throughout the claim, including during post-suit appraisal coordination. Clear Blue’s actions were consistent with industry standards and the duties imposed by the subject policy. Therefore, this allegation is wholly without merit and denied. Bad Faith: There is no basis for this allegation, thus it is denied. Complainants submit no facts or circumstances to substantiate a claim of bad faith. The Civil Remedy Notice merely restates statutory buzzwords without providing any supporting factual detail or explanation for how Clear Blue allegedly acted in bad faith. The undisputed facts set forth in the timeline below reflect that Clear Blue: • Promptly acknowledged and investigated the loss after the December 21, 2022 FNOL. • Inspected the property on December 28, 2022. • Issued a detailed estimate and a payment of $836.78 on February 1, 2023, along with an explanation of coverage, deductible, and recoverable depreciation based on the Roofing Materials Payment Schedule endorsement. • Responded to the Insureds’ supplemental claims by requesting additional documentation and ultimately invoking appraisal after mediation ended in impasse. • Retained a professional engineer to further investigate disputed damages. Clear Blue consistently acted in good faith, in compliance with the insurance policy and Florida law. At no time did Clear Blue delay, underpay, or improperly deny benefits owed under the policy. Rather, the claim remained open for further evaluation and resolution through appraisal. Therefore, the allegation of bad faith is baseless, conclusory, and unsupported by the factual record. CLAIM FACTUAL TIMELINE Due to the voluminous factual details that are relevant to the analysis of this claim, Clear Blue will begin its response to the alleged statutory violations with a recitation of known facts followed by a timeline of claim handling events set forth below. The purpose of setting out the facts in this manner is to highlight the misrepresentations in the facts asserted by Complainants and address them systematically. • July 15, 2022 – Policy inception date. • August 6, 2022 – Pre-loss underwriting inspection documented pre-existing damage to fascia, siding, window frames, loose shingles, elevated deck railings, and shed siding. Photographs and narrative confirmed deterioration and deferred maintenance at several exterior elevations. • September 28, 2022 – Hurricane Ian impacted the insured property. Insured later reported visible damage to fascia/overhangs and fencing. • December 21, 2022 – First Notice of Loss (FNOL) submitted. Claim initiated by the insureds. • December 22, 2022 – Clear Blue acknowledged the claim. Field inspection was scheduled. • December 28, 2022 – Site inspection performed by Clear Blue’s Field Adjuster. Insured present. Exterior damages observed to fascia, rolled roof decking, metal awnings, window screens, and fencing. No interior damage reported, and interior inspection declined. Photos documented lifted roofing material, broken fascia, cracked window screens, and propped-up fence sections. • January 15, 2023 – Scope of damages prepared. Total estimated Replacement Cost Value (RCV): $7,817.28. Coverage A amount fell below deductible after accounting for a Roof Materials Payment Schedule (RMPS) endorsement reducing roof RCV based on age. • February 1, 2023 – Payment of $836.78 issued under Coverage B for fencing. No Coverage A payment due to deductible. Coverage determination letter issued. Supporting estimate and policy documents provided to the insureds. • March 9, 2023 – Public Adjuster (PA) David Griffey of Day Adjusting & Consulting retained. Letter of Representation executed. • April 6, 2023 – Clear Blue issued written request for a Sworn Proof of Loss (SPOL), photos, and contractor estimates to the PA and insureds. • July 6, 2023 – PA submitted a detailed estimate totaling $105,816.61. Clear Blue acknowledged receipt of the estimate but noted that the Sworn Proof of Loss (SPOL) had not yet been received. The document received was not executed, signed, or sworn by the Insureds. • August 1, 2023 – Clear Blue assigned a licensed structural engineer to evaluate the property based on discrepancies between Clear Blue’s scope and the Insureds’ PA estimate. • August 14, 2023 – Clear Blue issued a Reservation of Rights (ROR) letter to the Insureds. The ROR letter referenced: o The outstanding Sworn Proof of Loss issues. o The ongoing engineer assignment. o Prior document requests (including contractor photos and estimates). • September 1, 2023 – Engineering inspection performed by EFI Global on behalf of Clear Blue. Findings included: o No storm-related damage to the main metal shingle roof. o Repairable damage to fascia and wood shakes. o Four windows with cracked or scratched glass—repairable without full replacement. o One damaged metal awning arm. o Fence inconsistencies noted; age of sections varied. o No gutter damage attributed to storm activity. • September 4, 2024 – Formal appraisal demand submitted by the PA on behalf of the insureds. The letter is dated March 14, 2024. • September 5, 2023 – Clear Blue sent an additional correspondence to the PA requesting documentation: specifically scope photographs and itemized contractor estimates to support claims for fencing, full window replacement, and roof replacement. • September 12, 2023 – Clear Blue attempted further engagement with the PA to discuss narrowing disputed scope issues (e.g., painting allowances, minor repairs versus full replacements). • September 18, 2023 – Clear Blue re-engaged the PA via email to address ongoing disputes and reasserted request for scope supporting documentation. • September 25, 2023 – PA correspondence stated Complainants was standing by original estimate with no revisions. • November 27, 2023 – the parties attended DFS mediation, which concluded in an impasse. • October 3, 2024 – Appraisal inspection conducted by Clear Blue’s designated appraiser, Travis Smith of Bauz Construction. Insureds were out of town; a neighbor granted interior access. No interior storm damage observed. Kitchen window had been replaced; other windows were aged but functional. Most fence sections appeared to have been previously repaired. • October 7, 2024 – Travis Smith reported back that the property condition generally matched earlier inspections. He observed no basis for full window replacement or total roof replacement as claimed in the PA estimate. • October 28, 2024 – Impasse reached regarding selection of a neutral umpire for the appraisal panel. Appraisers unable to agree on a third-party umpire. • December 20, 2024 – Complaint filed by the Insureds in Lee County, Florida for the appointment of a third-party umpire. • January 6, 2025 – The Insureds’ response to the Petition to Appoint an Umpire was due. They did not timely respond. • February 5, 2025 – Clear Blue’s counsel spoke to the Insureds’ counsel regarding resolving the issues in the Petition without the need for a hearing. Counsel was to provide proposed umpires and respond to the Petition. That did not occur. Clear Blue’s counsel even provided the professional courtesy of an extension to respond to the Petition. • February 12, 2025 – Clear Blue’s counsel followed up via email with the Insureds’ counsel regarding a response to the Petition to Appoint an Umpire. • March 12, 2025 – Despite having not timely responded to the Petition or to counsel’s follow ups, the Insureds’ filed this Notice falsely alleging delays by Clear Blue. • March 18, 2025 – Clear Blue’s counsel followed up via email with the Insureds’ counsel regarding a response to the Petition to Appoint an Umpire. • March 24, 2025 – Clear Blue’s counsel set another telephone conference with the Insureds’ counsel. Clear Blue’s counsel spoke to the Insureds’ counsel regarding resolving the issues in the Petition without the need for a hearing. Counsel was to provide proposed umpires and respond to the Petition. That did not occur. • March 26, 2025 – The Insureds’ finally responded to the Petition to Appoint an Umpire. • April 29, 2025 – The Court heard the Petition to Appoint an Umpire and we are pending the Court’s appointment of an umpire. Clear Blue also notes that during this time, the Insureds’ appraiser has acted belligerently towards Clear Blue’s appraiser launching false accusations and delaying the appraisal process. ALLEGED STATUTORY VIOLATIONS AND RESPONSES Complainants allege the following violations of Florida statutory law without factual support. Clear Blue refers to the detailed factual timeline above and incorporates it into each and every response below and Clear Blue responds as follows: Florida Statute §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.” RESPONSE: Clear Blue denies that it did not act in good faith to resolve the claim. Complainants submit no facts or circumstances to support this allegation. There is no basis for this allegation, thus it is denied. At no time did Clear Blue, its agents, or its employees make any settlement offer to Complainants, nor was one required under the circumstances given that Clear Blue was in the process of investigating and adjusting the claim. Clear Blue had requested additional information with supporting detail from the Complainants’ agents regarding the damages claimed by the Complainants and had valid concerns regarding the Subject Property after its initial inspection upon receipt of Complainants’ estimate. Clear Blue promptly investigated and extended payment within 45 days of FNOL. On 2/1/2023, payment of $836.78 was issued based on an itemized estimate. This payment reflected damage identified during the 12/28/2022 field inspection by adjuster Jason Ochs. Clear Blue’s scope included damage to wood fascia, awnings, patio screen, siding, and fencing. Additional damages were reviewed after the Insured submitted a PA estimate exceeding $100,000, which was not supported by the engineer’s findings. The company then retained EFI Global for a causation analysis, further confirming partial damages attributable to Hurricane Ian—many of which were repairable. Clear Blue did not delay or withhold payment in bad faith. It continued to seek a resolution through appraisal after mediation failed. In fact, Clear Blue filed a Petition to Appoint an Umpire when the parties could not agree, the Insureds failed to timely respond, selected the latest date provided for a hearing, and filed this Notice in the meantime. Florida Statute §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.” RESPONSE: There is no basis for this allegation, thus it is denied. Complainants submit no facts or circumstances to support this allegation. At no point did an obligation to settle this claim become “reasonably clear.” In fact, as the investigation progressed, it only became more evident that further investigation was needed as set forth in further detail in the argument section above. In addition, Clear Blue did not settle the claim “in order to influence settlements under other portions of the insurance policy coverage,” Clear Blue did not settle the claim because it had to conduct further investigation due to the concerns raised after the Insured submitted a PA estimate exceeding $100,000, which was not supported by the engineer’s findings. The Coverage B payment of $836.78 was issued independently of any dispute regarding Coverage A. No evidence exists that any part of the claim was leveraged to pressure resolution of another. Damages to the dwelling and fencing were adjusted separately and documented in the payment letter and summary issued on 2/1/2023. In fact, Clear Blue filed a Petition to Appoint an Umpire when the parties could not agree, the Insureds failed to timely respond, selected the latest date provided for a hearing, and filed this Notice in the meantime. Any delay was based on the Insureds, their counsel, and their appraiser in violation of Fla. Stat. 524.155(5). Florida Statute §624.9541(1)(i)(3)(a) “Failing to adopt and implement standards for the proper investigation of claims.” RESPONSE: Denied. There is no basis for this assertion. As supported by the above claim facts, Clear Blue conducted a prompt and thorough investigation into this claim and asserts its full and strict compliance with the contractual and statutory requirements imposed upon it. Complainants have not provided any facts or circumstances supporting this allegation whatsoever. On the contrary, the detailed factual timeline demonstrates that Clear Blue has gone above and beyond the requirements set forth by the policy and Florida law by giving Complainants and her agents numerous opportunities and requests for information that would further the claim investigation. In this claim, Clear Blue’s investigation proceeded promptly and in accordance with standard industry practices. Overall, Clear Blue has handled the claim in accordance with the policy and all statutory and regulatory requirements. As such, Complainants’ allegation is denied. All claims activity was in line with accepted investigation practices, and delays were largely due to documentation gaps created by Complainants, which were documented in Clear Blue’s 4/6/2023 proof of loss request and again in the 8/14/2023 reservation of rights. Florida Statute 626.9541(1)(i)(3)(b) “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” RESPONSE: Denied. Clear Blue has not made any misrepresentations to Complainants or her agents, whether material or otherwise. Clear Blue always acted fairly and honestly towards Complainants. Complainants offer no facts, nor do they cite any Policy language to support this allegation. The absence of any support for these allegations makes them patently false. Clear Blue’s correspondence to Complainants, including the coverage determination letter dated 2/1/2023, accurately quoted and applied policy terms (e.g., Roofing Materials Payment Schedule and non-recoverable depreciation clause). There is simply no evidence of misrepresentation. Overall, Clear Blue has handled the claim in accordance with the policy and all statutory and regulatory requirements. As such, Complainants’ allegation is denied. Florida Statute 626.9541(1)(i)(3)(c) “Failing to acknowledge and act promptly upon communications with respect to claims.” RESPONSE: Denied. Clear Blue promptly and repeatedly communicated with and responded to Complainants and Complainants’ agents in writing and orally. Clear Blue always acted fairly and honestly towards Complainants. Complainants offer no facts, nor do they cite any Policy language to support this allegation. As the record facts show, Clear Blue initiated contact one day after Complainants reported the loss, scheduled inspection within a week, and sent a settlement letter with payment on 2/1/2023. Clear Blue followed up on PA-submitted documents multiple times in April and August 2023. In fact, Clear Blue filed a Petition to Appoint an Umpire when the parties could not agree, the Insureds failed to timely respond, selected the latest date provided for a hearing, and filed this Notice in the meantime. Florida Statute 626.9541(1)(i)(3)(d) “Denying claims without conducting reasonable investigations based upon available information.” RESPONSE: There is no basis for this allegation, thus it is denied. Complainants submit no facts or circumstances to support this allegation and merely provide boilerplate restatements of statutory language to support this allegation. At no time did Clear Blue/Clear Blue, its agents, or its employees deny Complainants’ claim. Furthermore, Clear Blue has conducted an extensive investigation of the claim submitted by Complainants and relied upon engineers and building consultants as well as its own adjusters to proceed with the investigation. At all relevant times, Clear Blue/Clear Blue promptly advised Complainants that the investigation was ongoing and provided clear statements in writing to the Insured regarding the areas of disagreement for the scope of damages, citing to the specific policy language and declarations page of the subject policy that form the basis for the disagreements. In fact, this claim was simply not denied. On the contrary, coverage was opened and payment issued as documented in the factual timeline. The remaining dispute pertains to scope and value—currently being addressed pursuant to the Subject Policy’s appraisal provision. Complainants’ attempt to come forward now and claim bad faith despite the thorough investigations, requests for information, and appraisal is nothing more than a revisionist account of the claim handling proceedings that is not in line with the factual events as they actually occurred. Florida Statute 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.” RESPONSE: There is no basis for this allegation, thus it is denied. Complainants submit no facts or circumstances to support this allegation and merely provide boilerplate restatements of statutory language to support this allegation. At no time did Clear Blue/Clear Blue, its agents, or its employees deny Complainants’ claim or make an offer of a compromise settlement. As such, this allegation and statutory provision are both inapplicable. At all relevant times, Clear Blue/Clear Blue promptly advised Complainants that the investigation was ongoing and provided clear statements in writing to the Insured regarding the areas of disagreement for the scope of damages, citing to the specific policy language and declarations page of the subject policy that form the basis for the disagreements At all relevant times, Clear Blue promptly advised Complainants that the investigation was ongoing and provided clear statements in writing to the Insured regarding the areas of inquiry, citing to the specific policy language and declarations page of the subject policy that form the basis for the information sought. Complainants’ attempt to come forward now and claim bad faith is nothing more than a revisionist account of the claim handling proceedings that is not in line with the factual events as they actually occurred. Florida Statute 626.9541(1)(i)(3)(g) “Failing to promptly notify the insured of any additional information necessary for the processing of the claim.” RESPONSE: Denied. Clear Blue promptly and repeatedly communicated with and responded to Complainants and Complainants’ agents in writing and orally regarding the additional information necessary for the processing of the claim. For instance, the SPOL letter included the rationale for requiring an executed proof and scope photos to evaluate the large PA estimate submitted by Complainants. Clear Blue always acted fairly and honestly towards Complainants. Complainants offer no facts, nor do they cite to any Policy language to support this allegation. Clear Blue sent a written SPOL request on 4/6/2023, explicitly identifying required documents: contractor estimates, scope photos, and supporting loss documentation. A follow-up ROR on 8/14/2023 reiterated what was missing. Nevertheless, Complainants did not submit the SPOL in a timely manner; on July 6, 2023, Complainants’ public adjuster submitted a detailed estimate totaling $105,816.61 with no sworn proof of loss attached. Although a document titled ‘Proof of Loss’ was received by July 6, 2023, it was not executed or sworn by the Insureds. Florida Statute 626.9541(1)(i)(3)(h) “Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.” RESPONSE: Denied. Clear Blue promptly and repeatedly communicated with and responded to Complainants and Complainants’ agents in writing and orally regarding the additional information necessary for the processing of the claim, the nature of the requested information, and the reason why the information was necessary. Each request was clearly itemized and tied to either policy conditions (Duties After Loss) or comparison of scopes. For instance, the SPOL letter included the rationale for requiring an executed proof and scope photos to evaluate the large PA estimate. Moreover, the full policy, including all applicable endorsements, was provided to the PA on 4/6/2023, alongside the initial SPOL request. Clear Blue also referenced relevant provisions in the 8/14/2023 ROR, ensuring transparency. Clear Blue always acted fairly and honestly towards Complainants. Complainants offer no facts, nor do they cite any Policy language to support this allegation. GENERAL RESPONSE TO ALLEGED STATUTORY VIOLATIONS The Complainants failed to provide specific facts or circumstances relating to this claim supporting or justifying these alleged statutory violations. As there are no facts or circumstances explaining, supporting or justifying the alleged statutory violations, the Complainants failed to place Clear Blue on notice of any violation of the cited statute or any alleged conduct that may constitute bad faith. Moreover, the purported facts that were provided were inaccurate. Clear Blue has acted fairly and honestly toward the Insured at all times. Clear Blue inspected and photographed the property as soon as it was afforded an opportunity to do so. The claim was promptly investigated and adjusted in compliance with Florida law and the policy issued to Complainants. At no time has Clear Blue acted dishonestly or unfairly toward the Insured. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Therefore, these allegations are baseless and without merit. As there are no facts or circumstances explaining, supporting, or justifying the alleged statutory violations, Complainants failed to place Clear Blue on notice of any violation of the cited statutes or any alleged conduct that may constitute bad faith. Complainants have failed to satisfy the bad faith statute’s specificity requirement, given the multiple statutory violations and multiple policy provisions allegedly violated by Clear Blue, thus Complainants’ Notice is deficient and should be struck as a matter of law. See Julien v. United Property & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The Complainants presume, by these assertions, to state in the Civil Remedy Notice how Clear Blue can cure the alleged violations. However, the Notice sets forth a cure demand that is not compliant with Florida law. The amount sought by Complainants is altogether unclear because there is no final dollar value identified by Complainants that is curative under the circumstances. Specifically, Complainants does not provide the requisite amount of specificity to allow Clear Blue to cure any alleged violation because the cure demand includes undefined, vague requests for payment of “any recoverable depreciation once it has been incurred per the terms of the insurance policy.” The Notice does not provide a basis for this number, meaning Clear Blue is left to guess as to what a curative amount constitutes and would be unable to issue a curative payment within the 60-day cure period because the depreciation can be incurred after the expiration of the cure period. Further, the “cure” demands amount such as interest which are not contractually required in violation of Talat. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000). Finally, the “cure” requests that Clear Blue do something in the future well beyond the 60 days “cure” period at some unknown time when the Insureds complete repairs. As such, Clear Blue was denied the opportunity to cure in Complainants’ Notice. This failure to provide a proper opportunity to cure renders the Notice improper. See Longpoint Condominium Associations v. Allstate Insurance Co., 2005 WL 131580 (N.D. Fla. June 2, 2005). Clear Blue maintains that these proposed methods to cure are insufficient as the claim was properly adjusted, continues to be adjusted, and is currently in the appraisal process. Therefore, there was no wrongdoing as alleged by Complainants. In summation, the Notice does not provide a clear identification of how Clear Blue can cure the alleged statutory violations. The purpose of a Civil Remedy Notice is to provide the insurer an opportunity to “cure” the alleged wrongdoing. See Talat., 753 So. 2d 1278. The Notice does not serve this purpose, and for that reason is deficient and should be dismissed. Specifically, the Notice does not provide a proper means through which Clear Blue can “cure” the alleged defects. Clear Blue further denies any and all other allegations not specifically addressed in this response related to the above-referenced Civil Remedy Notice. There has been no violation of the referenced statutory sections by Clear Blue. By responding to the Civil Remedy Notice filed by Complainants, Clear Blue neither waives nor abandons but expressly reserves any and all rights, claims and defenses it has or may have under the terms and conditions of the Policy and applicable Florida law. Clear Blue has fully responded to the subject defective and improper Civil Remedy Notice. Clear Blue has not violated any of the subject statutes and the accusations made against it in the subject Civil Remedy Notice are false. Due to the lack of any factual basis to support such allegations and the incorrect reliance on Florida Statutes that are not applicable, we request, through this response, that the Department of Financial Services return the Notice for lack of specificity pursuant to Florida Statutes. Should the Florida Department of Financial Services have any questions or further inquiry with respect to this matter, please contact the undersigned. Thank you for your attention to this matter. Submitted by: /s/ Erick Rodriguez Katelyn Ferry, Esq. Erick Rodriguez, Esq. Cambo Ferry, PLLC 1000 Brickell Ave, Suite 715 Miami, FL 33131 O: (407) 236-1252 KFerry@camboferry.com ERodriguez@camboferry.com
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