Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 811829

Filing Accepted: 3/19/2025

Print Filing

Complainant

Last/Business Name *

PORTER

First Name

SHIRLEY

Street Address *

13475 NW 12TH AVENUE

City, State Zip *

NORTH MIAMI, FL 33168

Email Address *

MAINGOT@LRLC.LEGAL

Complainant Type: *

Insured

Last/Business Name*		PORTER		First Name		SHIRLEY
Policy # *		12-1003235-05		Claim #*		12-3019650-23

Attorney

Attorney is Applicable

Last Name*	MAINGOT First Name * MICHAEL Initial
Street Address*		16375 NE 18TH AVENUE, SUITE 321
City, State Zip*		NORTH MIAMI BEACH , FLORIDA 33162
Email Address *		MAINGOT@LRLC.LEGAL

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		TYPTAP INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 15885

Name of individual responsible for violation (if any):* DAISY PRINCESA
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Defrauding 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.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	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)(e)		Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
	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.

A. Coverage A – Dwelling and Coverage B – Other Structures. We insure against direct physical loss to property described in Coverages A and B. 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 initially pay the actual cash value of the building damage, minus any applicable deductible. We will then pay the necessary amounts actually spent to repair or replace the damaged building as work is performed and expenses are incurred. If a total loss, we will pay the replacement cost amount without deduction for depreciation. 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 upon the earliest of the following: 1. 20 days after we receive your proof of loss and reach written agreement with you; 2. 60 days after we receive your proof of loss and: a. There is an entry of a final judgment; or b. There is a filing of an appraisal award or a mediation settlement with us; or 3. If payment is not denied, within 90 days after we receive notice of an initial, reopened or supplemental claim. However, this provision (J.3.) does not apply if factors beyond our control reasonably prevent such payment.

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

TypTap ("Carrier") received claim for date of loss on November 15, 2023. The claim was reported shortly after the damage was observed. Claim was reported as a wind claim with damage to the roof and interior. Carrier sent out an independent field adjuster named Juan Soto. Carrier subsequently underpaid the claim on March 11, 2024, paying only $1,136.57 after deductible. Payment only included damages for the interior. Nothing was paid towards the roof. Insured initiated a lawsuit and deposed Juan Soto. In the deposition, it was discovered that Juan Soto, the carrier's independent field adjuster, found damages to the roof stemming from a very large tree branch that fell on the roof. On December 20, 2023, Mr. Soto wrote an estimate that called for a repair to the roof. This estimate was never sent out to the insured even though the carrier had a report and estimate from its own independent field adjuster that found roof and interior damages. The carrier then sent out Mr. Soto to inspect the property again. Mr. Soto again found damages to the roof stemming from a large tree branch falling on it. On March 4, 2024, Mr. Soto revised his estimate to include replacement of the roof. Still, the carrier did not issue payment at this time. On March 11, 2024, carrier issued a payment for $1,136.57 after the $2,500.00 deductible. This payment included an estimate from "Daisy Princesa". Curiously, Daisy Princesa never inspected the property. Also in her estimate, she removed any repairs for the roof, even though the carriers independant field adjuster found damages to the roof and even opined that it needed to be replaced. The carrier's desk adjuster, Daisy Princesa, removed all payments for the roof without any legitimate basis. Furthermore, the estimate was dated 12/27/2023, 3 months before the payment was issued. The carrier, in bad faith, sat on an estimate for around 3 months, then edited the independent field adjuster's estimate by removing any payment for the roof, without any reasonable basis, and even though their independent field adjuster confidently found that a tree branch had fallen on the roof. This constitutes bad faith for the reasons listed above. The carrier did not act fairly towards the insured when it hid Juan Soto's two estimate and edited his estimate by removing the roof repairs. The carrier has not implemented proper standards to ensure their desk adjuster's are making decisions based upon analysis from adjusters who inspected the home rather than their own apparent beliefs. The carrier delayed the claim by not paying out immediately when the carrier received the first estimate from Juan Soto. The carrier has still not provided any reasonable basis why the roof was removed. These actions were done in bad faith. To cure, the carrier must pay for all damages claimed by the insured that are recoverable under the policy and included in the insured's estimate.

Comments

User Id		Date Added		Comment
claims@typtap.com		05-16-2025		This is TypTap Insurance Company’s (“TypTap”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Shirley Porter (“Insured”). TypTap reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Regarding an aspect of the claim, TypTap issued payment for it on the information available to TypTap and the circumstances at the time of such payment. TypTap handled the claim in accordance with the policy and all statutory and regulatory requirements. TypTap denies each allegation of bad faith and improper conduct in the CRN. At all times, TypTap acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Otherwise, the CRN is deficient. Generally, pursuant to Florida Statutes, Section 624.155, CRNs must identify and set forth statutory provisions insurers allegedly violated in handling insureds’ insurance claims along with specific, relevant insurance contract language and facts and circumstances. The foregoing provides insurers with notice of alleged statutory violations AND the opportunity to cure such alleged violations. Instead of complying with Florida Statutes, Section 624.155, the Insured’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; and relied on inaccurate and conclusory statements. The Insured’s laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, the Insured’s attorney filed a lawsuit based on the claim prior to the filing of this CRN. Regardless of the fact there were no violations in this claim, any action by TypTap to cure violations alleged in the CRN could have been used against TypTap in the lawsuit. The foregoing shows abuse by the Insured and the Insured’s attorney of the CRN and legal processes. Also and generally, the CRN constitutes an abuse of the CRN process, contravenes the purpose of CRNs, which is to promote resolution of issues in insurance claims. The CRN must be rejected, and it cannot serve as the basis of any action against TypTap. Upon request by the Florida Department of Financial Services, TypTap will provide to the DFS detailed correspondence TypTap provided regarding the claim.

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