Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 811293

Filing Accepted: 3/14/2025

Print Filing

Complainant

Last/Business Name *

JOHNSON

First Name

RYAN

Street Address *

8843 HEARTSONG TERRACE

City, State Zip *

BOYNTON BEACH, FL 33473

Email Address *

CLAIMS@WINDLAWGROUP.COM

Complainant Type: *

Insured

Last/Business Name*		JOHNSON		First Name		RYAN
Policy # *		PKG701421738		Claim #*		401929968

Attorney

Attorney is Applicable

Last Name*	GALLAGHER First Name * ROBERT Initial
Street Address*		8570 STIRLING ROAD, SUITE 102-406
City, State Zip*		HOLLYWOOD , FL 33024
Email Address *		ROBERT@WINDLAWGROUP.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		AUTO CLUB INSURANCE COMPANY OF FLORIDA
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12813

Name of individual responsible for violation (if any):* THE ASSIGNED DESK ADJUSTER, FIELD ADJUSTER, SUPERVISOR(S) AND/OR MANAGER(S); AND ANY OTHER THAT HAS REVIEWED THIS CLAIM OR MADE DETERMINATIONS WITH RESPECT TO THIS CLAIM
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Unfair Settlement 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.
	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)(i)		Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).

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

AUTO CLUB INSURANCE COMPANY OF FLORIDA failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, AUTO CLUB INSURANCE COMPANY OF FLORIDA failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections, all endorsements and changes to the subject policy are relevant to the insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.

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

On or about June 7, 2024, while the insurance policy (Policy Number: PKG701421738) was in full force and effect, the subject property located at 8843 HEARTSONG TERRACE BOYNTON BEACH, FL 33473 sustained a covered loss as a result of wind damage from a tornado/wind storm The insured filed a claim (Claim Number: 401929968) per the terms of the insurance policy with AUTO CLUB INSURANCE COMPANY OF FLORIDA (the “carrier”). AUTO CLUB INSURANCE COMPANY OF FLORIDA received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. The carrier’s adjuster did not properly adjust the loss to include obviously related damages resulting from tornado/wind storm. The insured retained a representative, who performed a comprehensive investigation of the property that identified the damage that the carrier knew existed but failed to address. The insured’s representative determined there were damages and repairs necessary to restore the property to its pre-loss condition and submitted claim-related documentation to AUTO CLUB INSURANCE COMPANY OF FLORIDA, including a detailed estimate for repairs. AUTO CLUB INSURANCE COMPANY OF FLORIDA knows that it is acting in direct violation of Florida Statute 624.155(1)(b)(1) and that it has failed to issue proper payment for the claim to include damages and repairs covered by the insurance policy and Florida law. Rather than issuing the proper payment or attempting to reach an agreement with the insured, AUTO CLUB INSURANCE COMPANY OF FLORIDA is delaying and denying the claim. The carrier refuses to make any fair settlement offer to resolve this claim. Not made whole by the carrier per the terms of the insurance policy, the insured has been forced to seek legal counsel to protect the insured’s rights and interests. The above are all examples of AUTO CLUB INSURANCE COMPANY OF FLORIDA’S unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. These actions demonstrate the carrier is 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 the insured. The insured gives this notice to perfect the right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: (1) Pay the complete covered loss in the amount of $149,826.18, less any prior payments and less any applicable policy deductible; (2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and (3) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim.

Comments

User Id		Date Added		Comment
sbaltman@mdwcg.com		05-01-2025		May 1, 2025 VIA Electronic Mail Only – robert@windlawgroup.com Ryan Johnson c/o Robert Gallagher 8570 Stirling Road, Suite 102-406 Hollywood, FL 33024 RE: DFS #: 811293 DFS Acceptance Date: March 24, 2025 Complainant: Ryan Johnson Insured: Ryan Johnson Insurer: Auto Club Insurance Company of Florida Policy No.: PKG701421738 Date of Loss: June 7, 2024 Claim No.: 401929968 Dear Mr. Johnson: We have been retained by Auto Club Insurance Company of Florida (“Auto Club”) to respond to the above-referenced Civil Remedy Notice of Insurer Violations (“CRN”) filed by you on behalf of Ryan Johnson. (“Complainant or “Insured”). Auto Club welcomes the opportunity to respond to this CRN and denies each and every allegation contained in the CRN filed in relation to this claim. With that said, Auto Club believes that the CRN you filed fails to comply with the specific notice and information requirements as set forth in the Civil Remedy Notice of Insurer Violation document provisions, Florida Statute §624.155, and Florida Case law. THE CRN ALLEGATIONS The CRN asserts the following reasons for the notice: • Claim Denial • Claim Delay • Unsatisfactory Settlement Offer • Unfair Trade Practice • Unfair Settlement Practice Further, the CRN alleges Auto Club violated the following Florida statutes: 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)(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 releating to coverages at issue. 626.9541(1)(i)(3)(c) Failing to acknowledge and acto promptly upon communications with respect to claims. 626.9541(1)(i)(3)(d) Denying cIaims without conducting reasonabIe investigations based upon avai1ab1e information. 626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time period required by s.627.736(4)(b). DEFECTIVE NOTICE Florida Statute §624.155(3)(b) requires a Civil Remedy Notice “state with specificity” (1) the statutory provisions allegedly violated, (2) the facts and circumstances giving rise to the violation, (3) the name of any individual with knowledge of or responsible for the violation, and (4) the specific policy language relevant to the violation. Moreover, the Department created CRN DFS-10-363 form, which lays out 15 requirements that must also be responded to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant has specifically complied with all statutory requirements. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 878 (Fla. 4th DCA 2021). The insured has not complied with the statutory requirements. First and foremost, pursuant to Fla. Stat. §624.1551, a claimant must first establish the property insurer breached the insurance contract to prevail in a claim for extra-contractual damages under Fla. Stat. § 624.155(1)(b). The Insured has yet to establish Auto Club breached the Policy, and therefore this CRN is premature and must be rejected. Second, Florida Statutes require the Complainant, pursuant to section 624.155(3)(b)(4), to include “[r]eference to specific policy language that is relevant to the violation, if any”. However, the CRN refers to generic policy provisions and no provisions specific the insurance policy. As the CRN alleges that Auto Club failed to settle the claim in good faith, the failure to cite specific policy language impedes Auto Club’s ability to investigate or properly respond in addition to failing to satisfy the requirement of section 624.155(3)(b), (4) and Florida law. See Julien, supra. Third, Florida Statutes also requires a complainant, pursuant to § 624.155(3)(b)(1) to include “[t]he statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated”. The CRN filed in this matter cites several statutory provisions regardless to their applicability to the instant claim. The statutes cited in the CRN appear wholly irrelevant or inapplicable to the cited reasons for the CRN. For example, the CRN states that Auto Club has allegedly violated Florida Statute § 626.9541(1)(i)(3)(a) by “[f]ailing to adopt and implement standards for the proper investigation of claims.” However, the allegations in the CRN fail to provide any facts whatsoever to support this alleged violation. No actual specific facts or circumstances are set forth in the CRN as to how Auto Club’s standards, guidelines, or investigations are allegedly improper. Additionally, the CRN alleges a violation of a statute pertaining to Personal Injury Protection Benefits which is wholly inapplicable to this claim as this claim is a homeowner’s property insurance claim. Because the CRN fails to properly identify relevant applicable statutes, Auto Club is unable to properly respond and it does not comply with F.S. § 624.155 or Florida law. See Julien, supra. Further, contrary to the statutory requirement “to state with specificity… the facts and circumstances giving rise to the violation” as set forth in § 624.155(3)(b)(2), the purpose of which is “to enable the insurer to investigate and resolve [the] claim”, the CRN only provides boilerplate, broad, conclusory, unsupported and incorrect allegations with no basis in fact or circumstances. The allegations of the CRN essentially boil down to Complainant claiming Auto Club failed to pay the claim as demanded. However, the CRN does not provide any specific facts to support this. Because the CRN fails to properly identify the specific facts and circumstances allegedly giving rise to the allegations, Auto Club is unable to properly respond and it does not comply with F.S. § 624.155 or Florida law. See Julien, supra. Fifth, the CRN fails to name any individual involved in the alleged violation as required by Florida Statute § 624.155(3)(b)3. This failure to identify any individual allegedly involved to the purported violations prevents Auto Club from addressing any issues regarding these individuals and is one of the reasons why the CRN does not comply with Florida Statute § 624.155. Finally, the Insured’s cure provision demands Auto Club to “implement appropriate standards and procedures for claims investigation and resolution…” without the CRN providing any specifics as to how Auto Club failed to implement standards. A proper CRN requires the complainant “to enable the insurer to investigate and resolve your claim, describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” As can be seen, the CRN fails to provide any specific facts or circumstances giving rise to each specifically alleged violation. Further, the CRN itself only provides unsupported conclusory allegations with no basis in fact or circumstance. Notwithstanding these deficiencies, Auto Club denies it committed the alleged acts or violated the statutes cited and asserts this is as a reason why the CRN should be rejected. CLAIM HISTORY/FACTUAL BACKGROUND Setting forth the factual background, Auto Club issued insurance policy number PKG701421738 to the Insured, for the property located at 8843 Heartsong Terrace, Boynton Beach, FL 33473 (“Property”), providing coverage pursuant to the policy’s terms, conditions, limitations, endorsements and exclusions, for the policy. The Insured reported a tornado claim alleging a date of loss of June 7, 2024 and the claim was reported on June 29, 2024. Auto Club was advised the insured would be out of town of for 3 weeks and left the Public Adjuster’s (“PA”) number for the desk adjuster to contact him. It was reported that “roof damaged leaked into master bathroom tree branches also fell on roof and caused cracked tiles front left side of roof.” Auto Club acknowledged the claim and issued a Homeowner’s Bill of Rights. An independent adjuster inspected the property on July 12, 2024, took photographs and documented the conditions of the Property. He did not observe wind damages and observed that property was removed and repairs occurred. Auto Club issued a reservation of rights letter due to the insured’s potential violation of the Policy’s conditions. Auto Club then retained Keystone Engineering in order to further investigate the claim. Julian Sanchez, P.E., inspected the property on August 7, 2024. He concluded within a reasonable degree of engineering certainty the following: ? No shuffled, missing or displaced tiles consistent with exposure to wind were on the roof. ? Cracks and separations in the mortar around ridge cap tiles were consistent with typical drying or shrinkage cracks further affected by thermal expansion and contraction of the materials and were not caused by wind. ? Approximately four fractured field tiles, two on the northwest corner hip, one on the entrance gable, and one on the southeast slope above the master bathroom, were reported as being caused by tree branch impacts during a storm in June 2024. The provided timeline or wind-borne debris strikes were not consistent with the cracks. Rather, the damage to the affected tiles was consistent with increased foot traffic during prior repairs or other activities on the roof. ? The remaining cracked or chipped roof tiles were consistent with improper installation, thermal expansion and contraction of building materials, foot traffic, or other mechanical means and were not caused by wind or wind-borne debris impacts. ? The moisture-related damage in the master bathroom ceiling was consistent with rainwater intrusion through pre-existing openings that were due to prior repairs and were not caused by a storm event. Due to already completed roof repairs and removed finishes, Keystone was unable to provide a duration of the water intrusion. After a complete and thorough investigation, including two inspections of the property, on August 30, 2024, Auto Club denied the claim, citing the findings of the Independent Adjuster and the engineer. It also noted the applicable policy provisions which excluded or excepted coverage for the claim based on the factual determinations. STATUTES ALLEGED 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. As noted above, Complainant’s CRN lacks any factual specificity, support or basis to support this allegation. Notwithstanding the defective Notice, Auto Club acted fairly and honestly toward its Insured. It performed a full investigation of the Insured’s claim including two in-person inspections of the Property, issuing a prompt and proper claim determination based on the facts of the claim and the terms and conditions of the Policy, and evaluating and responding to all correspondence and documents it received in the claim. Auto Club has at all times investigated the Insured’s claim in good faith and with due regard to the Insured’s and Complainant’ interests. An insurer is not required to pay whatever an Insured or Complainant demands. While an insurance carrier is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested or disputed. Auto Club stands by its previous coverage determination and that the claim was adjusted properly in accordance with the terms and conditions of the Policy. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. As noted above, Complainant’s CRN lacks any factual specificity, support or basis to support this allegation. The CRN does not notify Auto Club what the so called standards are that Auto Club failed to adopt and implement. Auto Club cannot adequately respond. Nonetheless, it is clear from the claim history noted above, the Auto Club properly and thoroughly investigated this claim. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts of insurance policy provisions relating to coverages at issue. As noted above, Complainant’s CRN lacks any factual specificity, support or basis to support this allegation. Since Complainant does not state what facts or insurance policy provisions were misrepresented, Auto Club cannot properly and adequately respond to this CRN. Nonetheless, Auto Club properly issued its coverage determination in this matter explaining its findings of fact, citing the applicable provisions as they applied to those findings of fact and the ultimate coverage determination. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. As noted above, Complainant’s CRN lacks any factual specificity, support or basis to support this allegation. Nonetheless, Auto Club regularly communicated with and responded to the Insured or Insured’s representative in a timely manner, including, but not limited to, acknowledging the reporting of the claim, providing a homeowner’s bill of rights, coordinating inspections, and timely advising the Insured of its coverage decision. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. As noted above, Complainant’s CRN lacks any factual specificity, support or basis to support this allegation. Nonetheless, Auto Club conducted two on-site inspections of the Property, retained an expert, documented and photographed the condition of the property, reviewed documents received from the Insured and issued a proper coverage decision. 626.9541(1)(i)(3)(i): Failing to pay personal injury protection insurance claims within the time period required by s.627.736(4)(b). As noted above, this allegation is wholly inapplicable to the instant claim as this is not a claim for personal injury protection benefits. CONCLUSION As reflected above, there is simply no basis for the allegations made by Complainant in the CRN. Auto Club conducted a prompt and proper investigation of the Insured’s and Complainant’s claim and promptly made coverage determinations, fully explaining said determinations. There are simply no violations of any policy provisions or Florida statutes including, but not limited to, Fla. Stat. 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d) or 626.9541(1)(i)(3)(i), In closing, Auto Club first requests the CRN be rejected due to its failure to comply with Florida Statute § 624.155 and Florida case law, and regardless of the rejection, as demonstrated above, Auto Club has at all times acted in good faith, with due diligence, and in accordance with the terms of its insurance policy and Florida Statutes with respect to the handling of the Insured’s and Complainant’s claim. Auto Club expressly denies all allegations contained in the CRN. While this response is meant to be comprehensive, Auto Club’s response above is based upon the limited information provided in the CRN and the information we have to date. If the Complainant feels that we are not in possession of all the facts, please inform us immediately. Please note that Auto Club’s response is not necessarily exhaustive and does not preclude Auto Club from asserting any other valid reason for the lack of compliance with Florida Statute § 624.155. Also, this letter, or any act or failure to act on the part of Auto Club, or any agent or representative of Auto Club, should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service by Complainant, or any other rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust this response addresses the allegations of violations alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Respectfully submitted, Seth B. Altman Seth B. Altman cc: Auto Club Insurance Company of Florida

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