Civil Remedy Notice of Insurer Violations
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Filing Number:     811183
Filing Accepted:  3/14/2025
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Complainant
Last/Business Name *  
TERESAS FANJUL AND RAFAEL FANJUL   First Name  
Street Address * 4741 SE CHILES COURT
City, State Zip * STUART, FL 34997
Email Address * MOONGLOW916@COMCAST.NET
Complainant Type: * Insured
Insured
Last/Business Name*   TERESAS FANJUL AND RAFAEL FANJUL   First Name  
Policy # * 59-CJ-S093-2 Claim #* 59-77R2-75C
Attorney
Attorney is Applicable
Last Name* DAVIS First Name * JARED Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JDAVIS@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* CLAIM DEPARTMENT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
* 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)(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.

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

The carrier was put on notice of the insureds’ Hurricane Milton damage claim. Subsequently, the insured prepared a loss package in the amount of $57,915.60 needed to restore the property back to its pre-loss condition. The insureds have attempted to follow-up with the carrier multiple times regarding the status of the claim and have been ignored by the carrier. The insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insureds. More than one hundred and sixty days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insureds’ property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $57,915.60, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Erica De Jesus at (561)-892-9874 if you have any questions or concerns. Sincerely, Jared Davis Attorney at Law
Comments
User Id Date Added Comment
igreen@gaflaw.com 04-22-2025 Dear Mr. and Ms. Fanjul: Please be advised that the undersigned represents State Farm Florida Insurance Company (hereinafter, “State Farm®”) with regard to this matter. This letter shall serve as State Farm’s response to the Civil Remedy Notice of Insurer Violation (hereinafter, “Notice”) filed by attorney Jared Davis of Kanner & Pintaluga on your behalf. A civil remedy notice of insurer violation is a condition precedent to the commencement of bad faith litigation as set forth in Fla. Stat. 624.155. The purpose of a civil remedy notice is to provide the insurer with sufficient facts so that it has an opportunity to cure any alleged violation. Talat Enters. v. Aetna Ca. & Syr. Co., 753 So.2d 1278 (Fla. 2000); Lane v. Westfield Ins. Co., 862 So. 2d. 744, 788 (Fla. 5th DCA 2003). Without proper notice, an insurer is deprived of this opportunity. Thus, Florida courts have strictly construed the statute and require strict compliance with the statute’s notice requirements. Julien v. United Property & Cas. Ins. Co., 2021 WL 824438 (Fla. 4th DCA March 3, 2021). This Notice is invalid, legally insufficient and contains multiple defects. Specifically, the Notice identifies six different statutory sections that you are claiming State Farm has violated. However, the Notice fails to state the facts and circumstances that give rise to the alleged violations of Florida Statutes § 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), and 626.9541(1)(i)(3)(f), with sufficient specificity to allow the insurer to cure the alleged violation. The body of the Notice attempts to explain how State Farm’s investigation and handling of the claim was allegedly deficient. In reality, however, the Notice does nothing more than assert your apparent disagreement with State Farm’s investigation and the coverage determination under the policy. Thus, State Farm objects to the Notice based upon statutory defects and states that it is unable to provide a complete substantive response. Accordingly, the Notice is insufficient as a matter of law, and this letter does not waive such legal insufficiency in any way. See Lane v. Westfield Ins. Co., 862 So. 2d 774, 778 (Fla. 5th DCA 2003). Notwithstanding the lack of specificity of the Notice, and without waiving any objections thereto, or remedies or defenses available to State Farm because of those deficiencies or otherwise, State Farm states with a full reservation of its rights under Florida law that it has all times acted in compliance with its policy and Florida law. I. Claim Facts: On December 4, 2024, your attorney reported this Hurricane Milton claim to State Farm. Specifically, the claim was reported as wind damage to the backside of the roof, and that a tarp from a prior claim was blown off, with water staining to the interior and damage to the backside of the property. The date of loss was reported as October 9, 2024. On December 5, 2024, State Farm sent a claim acknowledgment letter to you. On December 13, 2024, State Farm called your attorney’s office to obtain more information related to this claim. However, no additional information was provided at that time. In correspondence dated December 16, 2024, State Farm advised you of your rights and duties under the policy. In correspondence dated December 26, 2024, State Farm sent your attorney a copy of the insurance policy and the coverage determination letter from your prior claim. On January 16, 2025, State Farm sent a letter to you reserving its rights under the policy and advising you that it was questionable whether the conditions of the policy were violated by the delay in giving notice of the claim and that it was questionable whether you had complied with the policy conditions set forth in Your Duties After Loss. Also on January 16, 2025, State Farm requested additional information from you with regard to the loss. Specifically, State Farm requested that you submit videos and photos of the damaged property prior to completion of mitigation and demolition; copies of all inspection reports and notes from roofer, contractor, mitigation vendor or any expert that has identified and can provide a detailed description as to the cause of the loss; and copies of protocols, estimates, invoices, word orders and material purchase receipts related to the scope of mitigation and repairs. Having not received any documents in response, on January 28, 2025, State Farm reiterated its request for documentation and also requested an examination under oath. As you know, you also submitted a prior claim to State Farm for wind damage to the roof with a date of loss of January 15, 2024, for which you have a pending lawsuit. As part of the defense of that lawsuit, State Farm retained an engineer to conduct an inspection of the insured property. As part of that inspection, the engineer provided State Farm with his opinions with regard to whether your property sustained any damage as a result of Hurricane Milton. The engineer’s opinions are as follows: • The fractured tiles on the Fanjul residence roof were the result of foot loading, maintenance/mitigation activities that would require traversing the roof covering, thermal expansion and contraction of the roof system, and/or prior repairs and were not due to direct or indirect wind damage on or around the provided date of loss of January 15, 2024, or during the passage of Hurricane Milton. • The ceiling discoloration stains in the second floor landing hallway and bedroom closet were the result of prior condensation moisture exposure from the HVAC ducting in the attic and not the result of moisture intrusion due to damage to the roof on or around the provided date of loss of January 15, 2024, or during the passage of Hurricane Milton. Upon review and analysis of the engineering report, it was determined that an examination under oath with regard to this claim was no longer warranted as the engineer concluded that there was no damage to your property related to Hurricane Milton. Thereafter, State Farm issued its coverage determination letter advising you that there are no covered damages. State Farm enclosed the engineering report for your review and set forth the applicable policy language. On March 20, 2025, State Farm received your Notice of Intent to Initiate Litigation. On March 24, 2025, State Farm timely responded to said Notice. As you can see from the facts above, State Farm has at all times acted promptly and in compliance with the policy and Florida law. Therefore, there is no basis for the Civil Remedy Notice filed on your behalf. II. Alleged Reasons for Notice: The Notice alleges multiple statutory violations. However, there are no specific facts or circumstances provided to support these allegations. Notwithstanding, State Farm denies each and every allegation of violation individually as follows: 1. Claim Delay: State Farm denies any delay in the claims handling process of the underlying loss as is evident from the facts outlined above. State Farm promptly acknowledged the claim and timely initiated its investigation, retained an engineer to inspect the property and timely issued its coverage determination based upon its findings. State Farm acted in accordance with its duties and obligations pursuant to the policy of insurance and acted promptly to advise you of the determination for the reported loss. Thus, this allegation is without basis and therefore denied. 2. Unfair Trade Practice: There is no basis for this allegation; thus, it is wholly denied. You have submitted no facts or circumstances to support this allegation. The facts show that State Farm acted promptly with respect to the investigation of the underlying claim and made communications as necessary to adjust the claim in a prompt and appropriate matter. Information necessary and relevant to the proceeding of the claim was communicated to you or your representatives in an appropriate manner. Thus, this allegation is without basis and therefore denied. III. Alleged Statutory Violations: The Notice asserts that State Farm has violated numerous statutory provisions. No specific facts or accurate recitations of circumstances are provided to support these allegations as required by statute, and State Farm denies all allegations and inferences. State Farm denies the allegations specifically as follows: 1. 624.155(1)(b)(1) Denied. There is no basis for this allegation, and therefore, it is denied. State Farm promptly acknowledged the claim and timely initiated its investigation, retained an engineer to inspect the reported damages and issued its coverage determination. The engineer did not identify any damages which were related to Hurricane Milton. Therefore, there is no coverage for this claim under the policy. State Farm acted honestly and fairly at all times during its investigation of the reported damage. Absolutely no facts or circumstances supporting this allegation have been provided by you in the Civil Remedy Notice. 2. 624.155(1)(b)(3): Denied. State Farm fairly and promptly investigated, evaluated, and determined coverage with regard to this claim. At no time did State Farm fail to settle a portion of the claim in order to influence a settlement under other portions of the policy. State Farm determined that there was no coverage for this claim based on the expert engineer’s findings. Therefore, no payment could be issued. Absolutely no facts or circumstances supporting this allegation have been provided by you in the Civil Remedy Notice. 3. 626.9541(1)(i)(3)(a): Denied. This allegation is without basis. State Farm has adopted and implemented standards for the proper investigation of claims at all times during the investigation of the subject matter. The aforementioned facts demonstrate that State Farm employed proper and customary claims practices in the investigation and adjustment of this claim including, but not limited to, inspection of the property and communications with you and/or your representatives. Accordingly, State Farm asserts its full and strict compliance with the statutory requirements imposed upon it. Finally, no facts have been submitted to support this allegation. 4. 626.9541(1)(i)(3)(b): Denied. This allegation is without basis. State Farm has been forthcoming and truthful regarding the pertinent claim facts and/or insurance policy provisions relating to the reported loss. State Farm’s correspondence and communications to you and your representatives prove this fact. Accordingly, State Farm asserts its full and strict compliance with the statutory requirements imposed upon it. Finally, you have submitted absolutely no facts or circumstances supporting this allegation. 5. 626.9541(1)(i)(3)(c): Denied. This allegation is without basis. State Farm has consistently acted promptly upon all communications with respect to this claim as previously outlined. State Farm has adjusted the underlying loss in as thorough and expedient a manner as possible. Moreover, State Farm routinely communicated with you and/or your representatives regarding the underlying claim. Thus, State Farm asserts its full and strict compliance with the statutory requirements imposed upon it. Any assertions to the contrary are unsupported by the facts. 6. 626.9541(1)(i)(3)(f): Denied. State Farm did not fail to provide an explanation for its coverage determination with regard to the claim. State Farm has conducted a reasonable investigation of the reported loss as referenced in the factual narrative above. After its investigation, State Farm issued correspondence to you explaining in detail why there was no coverage for the alleged damages. Thus, there is simply no support for this allegation, and State Farm asserts its full and strict compliance with the statutory requirements imposed upon it. IV. Alleged Violations of the Insurance Policy: The Notice fails to allege specific violations of the insurance policy and provides no specific facts or circumstances of wrongdoing. The failure to identify specific policy language renders this Notice defective. The Notice simply states “loss settlement provisions.” You therefore admit that you are not disputing State Farm’s coverage determination based on the policy language contained within its coverage determination letter. In the body of the Notice, you then reference the following: Section I – Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss Section I – Conditions, Loss Settlement Provision, requiring payment within 90 days. However, the above-language is not contained within the State Farm policy. For example, there is no section labeled “Perils Insured Against” in the State Farm policy. In addition, the Loss Settlement provision is not contained within Section I – Conditions, but rather is its own section in the policy. Furthermore, the provision within the State Farm policy which governs the time period within which payments are to be made is titled “Loss Payment.” State Farm denies that it violated any policy provisions applicable to the above-referenced matter or any other statute or rules of conduct. All actions by State Farm were completed in compliance with the applicable Policy. As indicated above, State Farm investigated and adjusted this claim in good faith. Thus, State Farm asserts that it has complied with the terms of the Policy by adjusting the loss with you and appropriately evaluating the reported claim. Moreover, State Farm asserts that it has appropriately communicated with you and/or your representatives during the disposition and handling of the underlying claim. Accordingly, State Farm asserts that it has complied with all applicable provisions of the Policy and Florida Statutes in the handling of this matter. V. Identification of Person or Persons Representing the Insurer Who are Most Responsible for/Knowledgeable of the Facts Giving Rise to the Allegations in this Notice. The Notice fails to identify any person whom you claim to be most responsible for or knowledgeable of the facts giving rise to your allegations. Instead, you state "Claim Department,” which seems to include every person associated with State Farm claims. Such an overbroad allegation does not satisfy the specificity requirement required by Florida statute and renders this Notice defective on its face. See Demase v. State Farm Fla. Ins. Co., 351 So. 3d 136, 141 (Fla. 5th DCA 2022)(“The ‘kitchen sink’ approach does not satisfy the specificity requirements of section 624.155.”); see also Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 879 (Fla. 4th DCA 2021). VI. Statements as to Curing the Alleged Defects in the Notice: The Notice is further deficient in that as a cure, the Notice seeks payment of the complete covered loss in the amount of $57,915,.60 less any prior payments and less any applicable policy deductible, and payment of statutory interest. Despite this demand, the method for curing violations alleged in a Civil Remedy Notice is not determined by the insureds. Talat Enters. v. Aetna Ca. & Syr. Co., 753 So.2d 1278 (Fla. 2000). Accordingly, Florida Statutes Section 624.155 does not impose on an insurer the obligation to pay whatever the insureds demand. Section 624.155(2)(d) would have no effect or purpose under such an interpretation. VII. Conclusion: State Farm takes very seriously its evaluation of claims under its policies. However, there is no coverage available under the policy with regard to the subject claim. State Farm has at all times, and continues, to act in compliance with the terms of the policy and Florida law. State Farm denies that it violated any statutes or committed the acts asserted in the Notice. State Farm neither waives nor is estopped from asserting any and all rights that it may have in law or under the terms of the policy. State Farm expressly reserves all such rights without exception or limitation. I trust that the foregoing adequately addresses any concerns that you may have concerning this matter. Thank you. Very truly yours, Ilana Green Kellner
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