Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 810898

Filing Accepted: 3/13/2025

Print Filing

Complainant

Last/Business Name *

AMOS

First Name

EARL AND DENISE

Street Address *

3266 GLENDYNE DRIVE EAST

City, State Zip *

JACKSONVILLE, FL 32216

Email Address *

AMOSEARLE@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		AMOS		First Name		EARL AND DENISE
Policy # *		7063177991		Claim #*		7007736595-1-2

Attorney

Attorney is Applicable

Last Name*	PIASECKI First Name * JACOB Initial D
Street Address*		4016 SOUTH THIRD STREET, #1156
City, State Zip*		JACKSONVILLE BEACH , FLORIDA 32250
Email Address *		JAKE@JDP-LAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		TRUCK INSURANCE EXCHANGE
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 21709

Name of individual responsible for violation (if any):* JOHN FRUGE, SPECIAL FIELD CLAIMS REPRESENTATIVE, TRUCK INSURANCE EXCHANGE; TIM STOCK, COMPANY EMPLOYEE ADJUSTER, SPECIAL FIELD CLAIMS REPRESENTATIVE, TRUCK INSURANCE EXCHANGE; AND EVERY ADJUSTER, AGENT, CLAIM REPRESENTATIVE, MANAGER, SUPERVISOR, DIR
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Unfair claim settlement practices.
	Other : Failure to conduct a reasonable investigation based on available information.
	Other : Failure to maintain proper claim handling procedures.
	Other : Misrepresenting the benefits, advantages, conditions, or terms of any insurance policy.
	Other : Misrepresenting the insurance policy provisions to the insured(s) or any person(s) with an interest
	Other : Misrepresenting Florida statutory provisions to an insured.
	Other : Misrepresenting facts to an insured.

* 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)(2)		A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
	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.

* 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 ARE AS FOLLOWS:*** FLORIDA ADMINISTRATIVE CODE SECTIONS & OTHER APPLICABLE STATUTES Fla. Stat. §626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state. 69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the insurance contract. 69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. 69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and applicable laws of the state of Florida. ******************************************************************************************** Earl Amos and Denise Amos consider the following specific policy language relevant to the Violation(s) described in this Notice: Farmers Florida Homeowners Declarations Property Coverage Coverage Limit Coverage Limit Coverage A - Dwelling $402,000 Coverage C - Personal Property Personal Property Replacement Cost $201,000 Covered Coverage B - Separate Structures $40,200 Coverage D - Loss of Use $80,400 Building Ordinance or Law Coverage 25% Agreement You agree: 1. to pay premiums when due; and 2. to comply with all applicable terms of this policy. In return, we will insure you for the coverages and limits as shown in this policy. This policy includes the Declarations and any endorsements. Definitions A. In this policy, "you" and "your" refer to the "named insured" shown in the Declarations and the spouse if a resident of the same household. "We", "us" and "our" refer to the Company providing this insurance. B. In addition, certain words and phrases are defined as follows: 1. "Actual cash value" means the reasonable replacement cost at time of loss less deduction for depreciation. We may depreciate all replacement costs, including, but not limited to, the costs of materials and labor. … 4. "Building Structure" means a structure which is a building that is fully enclosed with walls and a roof. A roof or wall does not include a temporary roof or wall structure or any kind of temporary tarp, sheeting or other covering, unless it has been installed temporarily and then only for a reasonable amount of time. … 7. "Claimed loss" means your claim of direct physical loss or damage to property. … 9. "Dwelling" - means the building or that part of the building used as the principal private residence structure located on the "residence premises". "Dwelling" does not include other structures. … 14. "Incurred property damage" in the Section I - Property Condition, Mediation and Appraisal means the verifiable, actual theft of or accidental, direct, distinct and demonstrable physical injury to or destruction of property. 15. "Insured" means: a. You and residents of your household who are: (1) Your relatives; or (2) Other persons under the age of 21 and in your care or the care of a resident of your household who is your relative; … 16. "Insured location" means: a. The "residence premises"; … Section I - Property Coverages A. Coverage A - Dwelling 1. Under Coverage A - "dwelling" we cover: a. The "dwelling" on the "residence premises" shown in the Declarations by address, 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". … B. Coverage B - Other Structures 1. Under Coverage B - Other Structures 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, sidewalk, driveway, patio or similar connection. … 10. Ordinance or Law a. The percentage for this coverage is stated in the Declarations. You may use up to this percentage of the limit of liability that applies to Coverage A for the increased costs you incur due to the enforcement of any ordinance or law which requires or regulates: (1) The construction, demolition, remodeling, renovation or repair of that part of the "dwelling" or other structure damaged by a Peril Insured Against; (2) The demolition and reconstruction of the undamaged part of a "dwelling" or other structure, when that "dwelling" or other structure must be totally demolished because of damage by a Peril Insured Against to another part of that "dwelling" or other structure; or (3) The remodeling, removal or replacement of a portion of the undamaged part of the "dwelling" or other structure "physically necessary" to complete the remodeling, repair or replacement of that part of the "dwelling" or other structure damaged by a Peril Insured Against. "Physically necessary" does not include where a building law does not directly apply to the covered damage, but a governmental authority will not approve or permit the remodeling, repair or replacement of the covered damage unless you or anyone acting on your behalf also complies with that building law. b. You may use all or part of this ordinance or law coverage to pay for the increased costs you incur to remove debris resulting from the construction, demolition, remodeling, renovation, repair or replacement of property as stated in a. above. … 13. Limited Fungi, Wet or Dry Rot, or Bacteria a. We will pay up to $10,000 per covered loss event for: (1) The total of all loss or damage payable under Section I - Property Coverages caused by "fungi", wet or dry rot, or bacteria; (2) The cost to remove "fungi", wet or dry rot, or bacteria from property covered under Section I - Property Coverages; (3) The cost to tear out and replace any part of the building or other covered real property as needed to gain access to the "fungi", wet or dry rot, or bacteria for remediation; and (4) The cost of testing of air or property to confirm the absence, presence or level of "fungi", wet or dry rot or bacteria. This applies whether performed prior to, during or after removal, repair, restoration, remediation or replacement. The cost of such testing will be provided only to the extent that there is a reason to believe that there is the presence of "fungi", wet or dry rot, or bacteria. A loss event includes all the foregoing loss or costs from "fungi", wet rot, dry rot or bacteria combined, including any Coverage D - Loss of Use expense. b. This Additional Coverage (1) Only applies if such "fungi", wet or dry rot or bacteria loss or costs are a direct result of a Peril Insured Against, which Peril Insured Against must occur during the policy period; and, (2) Only if all reasonable means were used to save and preserve the property from further damage at and after the time the Peril Insured Against occurred; and (3) Only applies to loss or costs from "fungi", wet rot, dry rot or bacteria which occur during the policy period. c. The most we will pay under this Coverage for all covered loss events during any one policy period is $20,000 in the aggregate. The limits for this Coverage apply regardless of the number of locations insured under this endorsement or number of claims made. d. If there is covered loss or damage to covered property, not caused, in whole or in part, by "fungi", wet or dry rot, or bacteria, then any loss payment because of the Peril Insured Against will not be limited by the terms of this Additional Coverage. However, this does not apply to the extent that "fungi", wet or dry rot, or bacteria causes an increase in the loss or costs. Any such increase in the loss or costs will be subject to the terms of this Additional Coverage. e. This is not additional insurance and does not increase the limit of liability applying to the damaged covered property or expense. … Section I - Perils Insured Against A. Coverage A - Dwelling and Coverage B - Other Structures 1. We insure against accidental direct physical loss or damage to the property described in Coverages A and B, unless the loss is excluded in Section - I Exclusions.

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

In Florida, insurance claims adjustment engages the public trust. Truck Insurance Exchange (hereinafter Farmers) breached this duty in its adjustment of claim number 7007736595-1-2 (the “Claim”) from Earl Amos and Denise Amos (“Mr. and Mrs. Amos ”) for their home located at 3266 Glendyne Drive East, Jacksonville, Florida 32216, (the “Property”). The Property was covered by a policy of insurance issued by the Insurer numbered 7063177991 (the “Policy”). Without limitation, Farmers: 1) failed to promptly pay all benefits due; 2) failed to fairly and completely investigate the Claim; 3) failed to act in due diligence and good faith to resolve the Claim; 4) placed its financial interests ahead of that of Mr. and Mrs. Amos ; 5) failed to properly train, evaluate, and manage adjusters so that policyholders receive fair, prompt, and accurate adjustment of claims in good faith; 6) failed to provide facts and reasons to Mr. and Mrs. Amos for elements and scope of the Claim that were not covered in its adjustment; 7) sought to delay full benefit payments and to “low ball” the Claim; 8) improperly denied coverage for the full scope of damages for the Claim without reasonable investigation; and 9) engaged in unfair claim underpayment and delay resulting in the violation of Florida statutes as set forth in this civil remedy notice. Specific Facts: Mr. and Mrs. Amos paid premiums to Farmers in exchange for the Policy which insured the Property against all direct physical losses unless specifically excluded. On or around January 9, 2024, the Property suffered significant damage from wind and wind-driven rain and debris, (the “Loss”). The Loss was a covered peril under the Policy. Mr. and Mrs. Amos reported the Loss to Farmers requesting an investigation, coverage admission, and full indemnity, less deductible. Farmers failed to handle the claim in good faith, breaching the Policy by denying coverage for the full scope of necessary, covered repairs; performing an inadequate investigation; and misrepresenting Policy coverage and exclusions. Farmers investigated and confirmed storm-related damages. Farmers sent a letter to Mr. and Mrs. Amos which confirmed partial coverage, denied the remainder, denied the full scope of covered repairs pursuant to the Policy, misrepresented policy coverages, and tendered payment of only $880.26 (the “Coverage Determination Letter”). Under Florida law, a specific refusal to pay a claim triggers a cause of action for breach of contract. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. State Farm Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991). It follows that Farmers breached the Policy when it issued the Coverage Determination Letter. Further, the argued exclusions or limitations to coverage do not contain unambiguous anti-concurrent causation language. Therefore, coverage may exist where an insured risk constitutes a concurrent cause of the loss, even if it is not the prime or efficient cause. Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694, 699 (Fla. 2016). Notwithstanding, Farmers refused and continues to refuse to pay all contract damages owed for the Loss. Concerned with the accuracy and completeness of Farmers’s investigation, Mr. and Mrs. Amos retained a licensed roofing contractor, Ecobuild Group, Inc. (“Ecobuild”), to investigate and evaluate the damage in accordance with industry standards and Florida law. Ecobuild concluded that a windstorm on or about January 9, 2024, including wind and rain, caused damage to the exterior of the insured property, particularly the roof warranting its replacement as well as the roof to the Property’s shed. Ecobuild’s report shows that at least $53,367.60 worth of repairs are necessary to return the property to its pre-loss condition. Farmers was provided with Ecobuild’s report. In contrast, Farmers’s investigation acknowledged wind damage to the roofing system. But it grossly overestimated the repairability of the roofing system and its necessary repairs, and it ignored clear and conspicuous wind damage to the roof of the shed and did not open coverage for necessary repairs. Mr. and Mrs. Amos’ roof is more than twenty (20) years old and is no longer repairable. It must be replaced. Farmers knew or should have known this fact had they properly investigated Mr. and Mrs. Amos’ claim. Notwithstanding, Farmers opened coverage and estimated for only repairs. On information and belief, Farmers intentionally underestimated the Claim in an effort to dissuade Mr. and Mrs. Jones from pursuing a claim for full roof replacement that is owed under the Policy. Farmers misadjusted the Claim by under-scoping covered damages and omitting full roof replacement for the main dwelling and the shed. Specifically, the wind damage to the Property’s roof and shed is covered under the Policy, and full roof replacement is the proper scope of repair. Farmers misapplied Policy coverages by not covering for full roof replacement. On March 13, 2025, Mr. and Mrs. Amos sent correspondence to Farmers, enclosing their Sworn Statement in Proof of Loss, along with the Ecobuild report outlining the cause, scope, and cost of the loss, the presuit settlement demand, the notice of intent to initiate litigation, the permit history of the Property’s roof, and requested Farmers to reconsider its coverage determination and partial denial and issue payment in accordance with their demand. Farmers’s coverage under-scoping of covered repairs, partial denial, and underpayment misrepresents the available coverages under the Policy in direct violation of Florida Statutes Sections: 626.9541(1)(a)(1) – misrepresenting the benefits, advantages, conditions, or terms of any insurance policy; 626.9541(1)(i)(3)(b) - misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; and 626.9541(1)(i)(2) - material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. As a result, Farmers has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of affecting settlement of the insureds’ claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Florida Statutes § 626.9541(1)(i)(2). Further, Farmers is in violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Florida Statutes § 626.9541(1)(i)(3)(d) - Denying claims without conducting reasonable investigations based upon available information by denying the insureds’ claim without conducting a reasonable investigation based upon available information. Farmers's under-scoping of covered damages, partial denial of coverage, and underpayment misrepresents the available coverages under the Policy in direct violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is pretext to wrongfully deny and delay this claim. It follows that Farmers has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of affecting settlement of the insureds’ claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Florida Statutes § 626.9541(1)(i)(2). Further, Farmers is in violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue. Farmers is also in violation of Florida Statutes § 626.9541(1)(i)(3)(d) by denying portions of the insureds’ claim without conducting a reasonable investigation based upon available information and Florida Statutes § 626.9541(1)(i)(3)(a) for failing to adopt and implement standards for the proper investigation of claims. Earl Amos and Denise Amos have made every effort to comply with all policy requirements, and it is only fair that the insurance company reciprocates the same. Farmers has failed to properly investigate the Loss and promptly indemnify the insureds causing delay. An insurer’s obligation to make prompt payment is an essential part of the contract for insurance, and an insurer’s failure to make prompt payment constitutes a breach of the implied covenant of good faith and fair dealing. Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla. 2000). Timely payment is particularly important here because Mr. and Mrs. Amos urgently need the funds to repair and replace damaged property. In summary, the Loss is clearly covered by the terms of the policy of insurance with Farmers as evidenced by Farmer’s own coverage determination. The investigation of Ecobuild -- based on (a) the data and information obtained; (b) age of the home and roof; (c) timing of damage; and (d) pattern and severity of damages shows that roof replacement is the necessary scope of repairs, and roof replacement is covered by the Policy, including necessary ordinance and law items to bring the Property’s roofing system to code. Notwithstanding, Farmers chose to underestimate, underpay, and partially deny coverage for the Loss. Despite clear evidence that the damages were covered and caused by a covered peril and that the roof is not repairable, the Claim was denied. To date, Farmers continues to deny Mr. and Mrs. Amos full indemnity for the claim. While Farmers refuses to honor this claim, a jury in Duval County will likely do what Farmers has refused; exercise the benefit of doubt in favor of the insureds in finding full coverage for the Loss. Under the Farmers all-risk policy, while Farmers provided insurance coverage, accidental direct physical damage occurred to the insured property far in excess to what Farmers provided coverage for in the Claim. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). With the data presented in Ecobuild’s investigation, Farmers’s burden to demonstrate by the greater weight of the evidence that all the physical damage to the insured property was caused solely by excluded perils under the policy and not in combination with a covered peril has not and cannot be met. See Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694 (Fla. 2016) (finding that even “[w]here weather perils combine with human negligence to cause a loss, it seems logical and reasonable to find the loss covered by an all-risk policy even if one of the causes is excluded from coverage.”). Despite clear indicators of covered damage and necessary scope of work for roof replacement, Farmers nevertheless inexplicably underestimated, partially denied and underpaid the Claim. The concept of insurance in a state like Florida, where adjustment of claims engages the public trust, necessitates that insurers fully and fairly value policyholder claims and issue timely payment for the full value of those claims according to the unambiguous terms of the involved policies. Farmers failed to do this for the Claim and thereby breached its duty to Mr. and Mrs. Amos . Additional wrongful conduct by the Insurer may exist that has not yet been discovered. Certain conduct or actions cannot be verified without a review of the Insurer’s claim file, claim guidelines, and other internal documentation. This notice is provided to Farmers so that it may cure the defects described herein, or so that Mr. and Mrs. Amos may pursue civil remedies pursuant to Fla. Stat. § 624.155 if Farmers does not cure. To cure, Farmers must: 1. Tender all monies due for the Claim pursuant to the Policy; 2. Pay statutory interest on the amount of unpaid contract damages from the date of loss to the date of cure pursuant to Florida Statutes § 627.70131. 3. Pay the insureds’ attorney’s fees and costs pursuant to Florida Statutes §§ 624.155 (or 627.428 or 626.9373 - repealed). 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
jake@jdp-law.com		04-03-2025		Please accept this submission as Complainants' withdrawal of this Civil Remedy Notice pursuant to settlement between the parties. Jake Piasecki, Esq., MBA FL Bar No. 108709 Law Office of Jake Piasecki, PLLC 4016 South Third Street #1156

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