Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 810809

Filing Accepted: 3/12/2025

Print Filing

Complainant

Last/Business Name *

MAPLE LEAF PUBLIC ADJUSTERS

First Name

Street Address *

365 FIFTH AVENUE SOUTH

City, State Zip *

NAPLES, FL 34102

Email Address *

KEVIN@MAPLELEAFCLAIMS.COM

Complainant Type: *

Third Party

Insured

Last/Business Name*		THOMPSON		First Name		LESLIE
Policy # *		FPH4150787-08		Claim #*		FPI245286

Attorney

Attorney is Applicable

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		FLORIDA PENINSULA INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10132

Name of individual responsible for violation (if any):* DAPHNE ROBINSON, YOLANDA WILLIAMS, DENISHA WADLEY, LAKAYLA DIAMOND, CYNTHIA WELCOME, DIEDRA JOHNSON, ERICKA ROMAN, JASON HALL, RAVEN JACKSON, NATALIE CASTELLANO, AND YOLANDA WILLIAMS.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Claim Denial
	Claim Delay
	Cancellation

* 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.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.

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

Protects against covered loss to your dwelling and structures attached to your dwelling. It also protects against covered loss to building materials located on your residence, which are being used in connection with your residence premises.

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

This is a Hurricane Milton claim, where the insured had a valid policy to cover the damages. An initial Field Adjuster’s Estimate of $78K was mistakenly sent to us before being revised to an amount below the deductible. However, we were never informed of who made the change or why, despite the requirement to disclose this information. We have made between 15-20 phone calls and sent 2-3 dozen emails seeking assistance, yet no one has provided any real help. Each time, we are given new names of individuals who are supposedly handling the claim, but we never receive any follow-up. When calling customer service, we are repeatedly told that the claim has been closed. It appears that their approach is simply ignoring us. Which may stem from the recent law changes of the attorney fees no longer being the responsibility of the carrier in the event of a victory for the plaintiff. Unfortunately, their blatant disregard for our client’s needs and repeated failure to address our multiple requests leave us with little else to say.

Comments

User Id		Date Added		Comment
pcole@conroysimberg.com		04-10-2025		We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed by Maple Leaf Public Adjusters relating to a claim made by Florida Peninsula Insurance Company’s Named Insured, Leslie Thompson, which was accepted by the Department of Financial Services on March 12, 2025, and assigned Filing No. 810809. The CRN revolves around a claim (FPI245286) filed for alleged damage from a windstorm, named Hurricane Helene, that occurred on September 26, 2024 at the Insured’s single-family residence located at 2308 Palma Sola Boulevard, Bradenton, Florida 34209. The home was built in 1975 and is comprised of a shingle roof that was installed in 2016. At the time of loss, the Insured’s home was covered under an HO3 Policy, Policy number FPH4150787-08, issued by Florida Peninsula Insurance Company (“The Company”). At the outset, it should be stated that the CRN is defective and does not conform with the requirements of filing a CRN as it contains inaccurate factual allegations, lacks the required specificity and does not provide an opportunity for the Company to reasonably respond to the alleged violations contained in the CRN. The CRN merely contains conclusory reasons for the Notice, such as failing to settle claims in good faith, and failing to acknowledge and act promptly upon communications, to name a few. For example, the Notice alleges that the Company violated the following statutory provisions of Florida Statutes §624.155: • §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all other 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. • §626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. The CRN fails to identify specific facts as related to the broad and conclusory allegations. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). Notwithstanding, the Company explicitly denies violations of any applicable Florida Statute in the adjustment of the referenced claims. The Company specifically denies that it has not attempted in good faith to settle the Insured’s 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 Insured’s interests. Moreover, the Company specifically denies that it refused to properly investigate the claim or refused to tender all insurance proceeds without waiver of its objections, rights and defenses, the Company maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insured’s claim, and wishes to dispel even the inference of any violation, and reiterates below the reasons which clearly show the proper handling of the Insured’s claim. Additionally, the Civil Remedy Notice fails to identify a “cure” for the alleged defects. As a result, Florida Peninsula Insurance Company objects to the CRN as it is defective and should be rejected. In order to understand the deficiencies of this Notice, however, and reserving all objections to the subject CRN, the background of this case is necessary. On September 27, 2024, the insured reported this Hurricane Helene claim as having occurred on September 26, 2024. The insured reported damage to interior and exterior of the home. It is important to note that from the start, Florida Peninsula Insurance Company (the “Company”) communicated with its Insured and/or her representatives on a regular basis. In fact, when the claim was reported on September 27, 2024, a first notice of loss letter acknowledging the claim was immediately sent out to the insured advising the homeowner of her Bill of Rights as an Insured, and her pre-suit mediation opportunities. Further, later in the claim adjustment process, the Insured was advised of those same rights again, so it was very clear that the Insured was informed of what she could do to protect herself under the circumstances should she disagree with the Carrier’s handling and decision. Upon reporting of the loss, the Company assigned the claim to a field adjuster (the “FA”). On October 22, 2024, the FA conducted an inspection of the subject property. The FA carefully assessed and evaluated the claimed damage, which included a thorough inspection of the roof, exterior, and interior of the property. The insured retained a public adjuster (“PA”) from Maple Leaf Public Adjusters who provided a letter of representation on October 26, 2024. The Company sent a certified copy of the insurance policy to the PA on November 11, 2024 as requested. On October 27, 2024, the Company sent an email to the insured containing a link to the two damage estimates generated by the Company along with a detailed Estimate Change Form. The same email was provided to the insured’s PA on October 28, 2024. The email stated: “This is being sent to you as required by Florida statute 627.70131 - "Insurer's duty to acknowledge communications regarding claims; investigation" section (3)(e), which states the following: (e) The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. This paragraph does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation. Please be advised that any attached estimates of the amount of the loss generated may be preliminary in nature and before we have concluded our investigation of your claim. Such preliminary estimates, if any, do not constitute coverage decisions or decisions regarding the value of the damage or the amount of benefits due. You will be notified when a coverage decision is made and provided with an explanation of our decision, including a final estimate of covered damage, when applicable.” The Estimate Change Form included detailed information including identification of the Estimate Line-Item Number, Line-Item Description, Change From Quantity/Dollar Amount, Change To Quantity/Dollar Amount, and Reason for Change. By letter dated October 28, 2024, a coverage determination was issued wherein the again provided the insured with its itemized estimate and statement of loss, and advised the Insured, based on the estimate, the damage to the property was less than the insured’s contractual deductible which was $10,472.00. As such, the Company advised that it was unable to issue payment for the claim. The letter advised the insured that she could access prior working drafts of the estimate by contacting her adjuster directly, or Claims Customer Service using the toll-free number contained within the letter. The October 28th coverage determination also advised the insured that during the investigation it was discovered that the damage sustained to the flooring and drywall throughout the home was caused by flood and rising water, therefore, it was issuing a partial denial for the portion of the claim. The Company explained that the policy did not include coverage for damage resulting from flood even if hurricane winds and rain caused the flood to occur. Additionally, the Company advised that without separate flood coverage, the insured may have uncovered losses caused by flood. Again, with the October 28th coverage determination, the Company provided the insured with its estimate, statement of loss, and an excerpt detailing the applicable policy language clarifying the Company’s decision. The PA then submitted its estimate on November 7, 2024 in the amount of $230,767.16. On emails dated January 21, 2025 and January 23, 2025, the PA advised the Company that it was disputing the amount of the Company’s estimate and that there was a “large discrepancy between” the PA’s estimate and the Company’s estimate. The PA alleged that they believed the “correct estimate was sent, someone didn’t like it internally, changed it and resent another one with no payment.” The PA’s allegation above is simply untrue. By email dated January 23, 2025, the Company resent its October 27, 2024 email to the PA which contained a link to the two damage estimates generated by the Company along with a detailed Estimate Change Form. Again, the Estimate Change Form included detailed information including identification of the Estimate Line-Item Number, Line-Item Description, Change From Quantity/Dollar Amount, Change To Quantity/Dollar Amount, and Reason for Change. By letter dated February 19, 2025, the Company issued a supplemental coverage determination. The letter advised the insured that the Company had completed the investigation and evaluation of the supplemental claim. The Company enclosed a copy of its itemized estimate and statement of loss, and advised that, based on the estimate the damage was less than the insured’s deductible. As such, the Company was unable to make a payment for the claim. The correspondence again advised that that the insured could access prior working drafts of the estimate by contacting her adjuster directly, or Claims Customer Service using the toll-free number contained within the letter. The February 19th letter further advised that based on the investigation of the claim and the terms of the policy, it had determined there was no coverage for part of the claim. The Company advised that it had reviewed the PA’s estimate and supporting documents for a full roof replacement. However, its inspection of the roof revealed that the damage was repairable. The Company advised that in good faith, it had applied the Matching of Undamaged Property Endorsement, and noted that no further indemnity could be paid for Matching of Undamaged Property. The Company further advised that there was no coverage for damage caused by wind-driven rain, unless a covered peril first damages the building causing an opening in a roof or outside wall, door or window and the rain, snow, sleet, sand or dust enters through such opening. The Company explained its investigation determined no evidence of any peril created damage causing an opening to the roof of the home which would have allowed rainwater to enter the kitchen, and the observed ceiling water damage in the interior of the home was found to be consistent with wear, tear, and deterioration, as well as pre-existing damage from prior repairs. The Company advised that damage had occurred over an extended period of time, rather than as a direct result of a covered peril, and the policy did not provide coverage for damage caused as a result of wear and tear, marring or deterioration. The Company also advised that its site inspection and subsequent investigation determined that the damage to the interior of the living room, kitchen, master bedroom, closet, master closet, bathroom, bedroom 2, bedroom 3, laundry room, garage, and exterior elevation walls was the result of flooding. The Company explained that, unfortunately, the subject policy did not provide coverage for loss caused directly or indirectly by flood, surface water, waves, tidal water, overflow of a body of water, or spray from any of these, whether or not driven by wind and such loss was excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. Additionally, the Company advised that after a thorough investigation and a review of historical images, it identified that the damage to the exterior elevation walls was pre-existing and a result of settling, earth movements, wear, tear, deterioration, and faulty maintenance. The Company advised that those factors were specifically excluded from coverage under the terms of the policy, and as such, it was unable to provide coverage for that portion of the loss. The Company closed the February 19th correspondence by advising the insured that this concluded the handling of the claim and the claim file had been closed. Policy excerpts detailing the applicable policy language was provided to the insured clarifying the Company’s decision. Maple Leaf Public Adjusting then filed the Civil Remedy Notice with the Department on as a third-party complainant on March 12, 2025. The PA complains that the Company arbitrarily changed its estimate, “mistakenly” provided it to the insured, and was never informed of who made the change or why. Florida Peninsula Insurance Company has complied with Florida statute 627.70131 and provided the insured and her representatives with its damage estimates generated by the Company along with a detailed Estimate Change Form outlining the changes made and the reasons for the changes. The Insured’s PA also complains that there is a disagreement as to scope and pricing in this case, among other items. While that might be true, that does not rise to the level of a statutory violation, it is merely a disagreement with the value of the loss. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. Florida Peninsula Insurance Company has communicated with its Insured and her representatives as required. Florida Peninsula Insurance Company has inspected the loss and damages thoroughly and given a thorough assessment of its findings and conclusions made. The fact that Florida Peninsula Insurance Company was not in agreement with the position of the Insured or her representatives and the estimates prepared on her behalf, does not rise to the level of statutory violations. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. As demonstrated above, the Company has, thus far, undertaken a thorough adjustment process and investigation, and the decision that it has made as to what is compensable and what is not has been amply explained to the Insured. The Company has, at all times, acted fairly and promptly toward its Insured and with full regard to her interests, and has complied with its obligations in this claim process. Any further information which may be required is available upon request.

Acknowledgement
*	The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

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