Civil Remedy Notice of Insurer Violations
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Filing Number:     811836
Filing Accepted:  3/19/2025
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Complainant
Last/Business Name *  
DEGENNARO   First Name   BRITT
Street Address * 800 E BROWARD BLVD, SUITE 510
City, State Zip * FT LAUDERDALE, FL 33301
Email Address * BD@WEKLAW.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   AGUILERA GONZALEZ   First Name   EDWAR OMAR
Policy # * PFL349375-06 Claim #* CFL24602475
Attorney
Attorney is Applicable
Last Name* DEGENNARO First Name * BRITT Initial
Street Address* 800 E BROWARD BLVD, SUITE 510
City, State Zip* FT LAUDERDALE , FL 33301
Email Address * BD@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* JOHAN GOMEZ
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
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)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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)(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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The policy language in dispute in Claim #CFL24602475 revolves around People’s Trust Insurance Company’s (PTI) reliance on policy exclusions and conditions to deny coverage for damages caused by Hurricane Ian. PTI’s denial was primarily based on three provisions within the Homeowners 3 – Special Form Policy, which the insurer misapplied to justify its refusal to indemnify the insured despite clear evidence of hurricane-related damage. The first and most critical policy provision in dispute is the storm-created opening requirement. PTI denied the insured’s claim on the basis that rainwater intrusion into the home’s interior was not covered unless a “covered peril” first created an opening in the roof or walls. According to the policy, PTI does not insure for loss caused by rain unless “a covered peril first damages the building causing an opening in a roof or wall and the rain enters through this opening.” PTI took the position that no such storm-created opening was present and, therefore, the interior water damage was not covered under the policy. However, this determination was based on a superficial and outcome-driven inspection, ignoring clear evidence of storm-related shingle displacement, wind-driven damage, and potential entry points for water intrusion. The insured’s representatives, including Integrity Claims Group LLC and legal counsel, challenged PTI’s interpretation, arguing that Hurricane Ian’s high winds caused substantial damage to the roofing system, displacing shingles and allowing rainwater to enter. Despite this, PTI maintained its position, failing to adequately address how wind-driven rain could have entered through storm-damaged areas of the roof, even if a large structural opening was not immediately visible. The second major policy provision in dispute involves exclusions for wear and tear, deterioration, and pre-existing conditions. PTI’s denial letter heavily relied on exclusions stating that the insurer does not cover loss caused by wear and tear, marring, or deterioration. According to PTI’s field adjuster’s report, as well as the Keystone Experts & Engineers report, the roof displayed granular loss, mechanical damage, and prior repairs—all conditions the insurer used to assert that the damage was not caused by Hurricane Ian but rather due to aging and lack of maintenance. However, this assessment was biased, incomplete, and ignored crucial evidence regarding the storm’s impact. PTI’s inspections failed to determine whether Hurricane Ian contributed to or exacerbated the roof’s pre-existing conditions, despite the fact that wind forces can worsen aged roofing systems, causing functional damage that would otherwise not have occurred absent the storm. More notably, Keystone’s own report acknowledged the presence of tree-related damage on the roof but refused to consider whether Hurricane Ian’s strong winds caused the impact, instead categorizing it as pre-existing wear. PTI’s selective interpretation of the engineering findings demonstrates that its denial was not based on a fair and neutral application of the policy but rather a pre-determined effort to deny coverage. The third and final policy provision in dispute is the insured’s duty to provide prompt notice of the loss. PTI cited a policy condition stating that the insurer has “no duty to provide coverage if the failure to comply with post-loss duties is prejudicial to the insurer” and that the insured must provide prompt notice of a loss. While it is true that the insured reported the claim 617 days after the date of loss, PTI failed to establish that this delay actually prejudiced its ability to investigate the claim. Instead of demonstrating how the late reporting impaired its assessment, PTI used this provision as an additional pretext for denial without proving that it had suffered material harm. Courts have consistently ruled that an insurer must show actual prejudice resulting from delayed notice before using late reporting as a reason for denial. However, PTI’s denial letter made no attempt to quantify what specific evidence, if any, was lost due to the delay, nor did it attempt to conduct a meaningful investigation that could have accounted for the passage of time. Furthermore, when PTI conducted its inspections in June and September 2024, it had ample opportunity to perform forensic assessments that could have determined the cause of loss, yet it chose not to. Instead, PTI weaponized the late notice provision to deny the claim outright, despite failing to meet its burden of proving prejudice. In summary, PTI’s denial of Claim #CFL24602475 was based on misinterpretations of policy language designed to justify its refusal to indemnify the insured. The insurer improperly applied the storm-created opening requirement without accounting for evidence of storm-related shingle displacement and water intrusion. It over-applied wear and tear exclusions while ignoring whether Hurricane Ian exacerbated the damage and failed to justify its assertion of prejudice due to late reporting. The insured maintains that PTI intentionally misrepresented policy language, selectively interpreted engineering findings, and ignored key evidence to deny the claim in bad faith rather than adjust it fairly.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

CIVIL REMEDY NOTICE COMPLAINANT: EDWAR OMAR AGUILERA GONZALEZ INSURER: PEOPLE’S TRUST INSURANCE COMPANY CLAIM NUMBER: CFL24602475 POLICY NUMBER: PFL349375-07 DATE OF LOSS: SEPTEMBER 28, 2022 DATE OF NOTICE: MARCH 19, 2025 Edwar Omar Aguilera Gonzalez, the named insured under the above-referenced homeowner’s insurance policy, submits this Civil Remedy Notice against People’s Trust Insurance Company (hereinafter “PTI”) for its failure to act in good faith in handling and adjusting his claim following Hurricane Ian. Despite clear and compelling evidence of storm-related damage to the insured property, PTI has deliberately delayed, denied, and misrepresented facts and policy provisions in an effort to wrongfully withhold coverage, in violation of its contractual and statutory obligations. Hurricane Ian struck Florida on September 28, 2022, causing significant damage to the insured’s home located at 184 NW 37TH WAY, Deerfield Beach, Florida 33442. The damage included roof failures, wind-damaged shingles, water intrusion, ceiling and interior wall damage, and other property losses. Due to logistical delays in securing an assessment of the damage and PTI’s failure to conduct a timely and fair investigation, the insured was not able to report the claim until June 6, 2024. However, despite the delayed reporting, PTI had a duty under Florida law to conduct a fair, impartial, and complete investigation to determine whether coverage was warranted. Instead, PTI immediately set out to manufacture a justification to deny the claim rather than assess it objectively. Upon receiving the claim, PTI issued a Reservation of Rights letter on June 16, 2024, citing the delay in reporting as a potential basis to prejudice the claim investigation. However, PTI failed to provide any evidence that the delay prevented it from determining the cause of the damage. Rather than using this as an opportunity to properly investigate, PTI preemptively positioned itself to deny the claim regardless of the evidence available. On June 18, 2024, PTI’s field adjuster conducted an inspection of the property. The insured reported missing and displaced shingles, roof leaks, and significant interior water damage, all of which were consistent with wind-driven storm damage from Hurricane Ian. However, the adjuster’s findings ignored key aspects of the reported damage, failed to document certain impacted areas, and relied on a pre-scripted narrative that heavily favored denial. The adjuster did not thoroughly investigate alternative causes for the loss and simply attributed all observed damage to “age-related deterioration, prior repairs, and mechanical damage” without any objective basis for that conclusion. The adjuster did not provide any meteorological data, forensic wind analysis, or detailed findings that would support the rejection of hurricane-related wind damage. Based on this biased and incomplete inspection, PTI issued a Coverage Denial Letter on June 25, 2024, rejecting the insured’s claim entirely. PTI asserted that the roof damage was due to wear and tear, granular loss, and prior repairs rather than hurricane-force winds. Additionally, PTI claimed that no storm-created openings were found, and therefore, the interior water damage was not covered under the policy. PTI’s denial letter made broad references to policy exclusions without explaining how they applied to the specific facts of this claim, reinforcing the conclusion that the decision to deny coverage had been made before any meaningful investigation took place. To challenge PTI’s bad-faith denial, the insured retained Integrity Claims Group LLC on June 4, 2024, to conduct an independent assessment. The public adjuster’s findings revealed significant evidence that the damages were the direct result of wind forces associated with Hurricane Ian. The insured also engaged Weisser, Elazar & Kantor, PLLC, who submitted a Notice of Intent to Initiate Litigation (NOI) on August 29, 2024. The NOI provided extensive details regarding PTI’s failure to conduct a reasonable investigation, its reliance on unsubstantiated policy exclusions, and its refusal to address the actual cause of the damages. In response, PTI agreed to conduct a joint reinspection with Keystone Experts & Engineers on September 6, 2024. However, rather than conducting an unbiased evaluation, Keystone’s approach was clearly intended to validate PTI’s prior denial rather than assess the damages objectively. Keystone acknowledged evidence of tree damage to the roof, yet it failed to consider whether this damage was caused by Hurricane Ian. Instead, Keystone’s findings ignored the possibility that wind-driven debris or high-velocity gusts had contributed to the damage, instead attributing all observed issues to “tree rub” and “normal aging.” This demonstrates that Keystone’s inspection was not an independent assessment but a pre-determined justification for PTI’s denial. Keystone’s final report, submitted on September 11, 2024, reiterated PTI’s original findings almost verbatim, claiming that the roof damage resulted from age-related wear, pre-existing repairs, and mechanical damage rather than hurricane-force winds. The report failed to account for the actual conditions on the date of loss, failed to provide a reasonable alternative explanation for missing shingles, and ignored the fact that the insured had no significant prior roofing issues before Hurricane Ian. It also neglected to include a detailed wind-force analysis that would have provided an objective basis for its conclusions. Despite these glaring deficiencies in its investigation, PTI reaffirmed its denial of coverage on September 11, 2024, offering the insured a nominal pre-suit settlement of $100.00. This offer was clearly made in bad faith, as it bore no relation to the actual cost of repairs or the extent of the insured’s losses. PTI’s unreasonable and inadequate settlement offer was nothing more than an attempt to pressure the insured into accepting an unjustified denial rather than compensate him fairly under the policy. PTI’s conduct in handling this claim constitutes clear violations of Florida Statute §624.155, including: People’s Trust Insurance Company’s (PTI) handling of Claim #CFL24602475 was riddled with statutory violations that demonstrated its systemic bad-faith practices. PTI repeatedly failed to conduct a fair and impartial investigation, misrepresented policy provisions, undervalued the insured’s damages, and obstructed the insured’s ability to recover benefits under the policy. These violations resulted in significant financial hardship and undue delays, leaving the insured unable to repair his home despite faithfully maintaining his insurance coverage. Each of these violations is detailed below with factual support. PTI failed to adopt and implement proper standards for the investigation of claims by conducting a superficial and incomplete evaluation of the insured’s property following Hurricane Ian. When the claim was reported on June 6, 2024, PTI had a duty to conduct a thorough and impartial assessment to determine whether coverage applied. Instead, PTI dispatched an adjuster who performed a cursory inspection on June 18, 2024, and disregarded key evidence of storm-related damage. The adjuster’s report lacked detailed analysis of wind impacts, storm-related shingle displacement, or structural water intrusion. Rather than performing a proper forensic evaluation, PTI defaulted to a denial, citing generic exclusions such as wear and tear, deterioration, and pre-existing damage—without proving that these were the actual causes of loss. This failure to establish investigative standards resulted in an unfair and unsupported coverage determination that was not based on industry-accepted claims adjustment practices. PTI misrepresented pertinent facts and policy provisions to justify denial by selectively interpreting policy exclusions and ignoring relevant facts that supported coverage. In its June 25, 2024, denial letter, PTI asserted that the policy does not cover rainwater intrusion unless a storm-created opening exists. However, PTI failed to acknowledge or evaluate whether wind forces from Hurricane Ian displaced shingles, weakened roofing materials, or otherwise contributed to the water damage inside the home. PTI’s adjuster did not document a full shingle-by-shingle assessment or provide a forensic wind analysis that could have determined whether storm-related uplift occurred. Furthermore, PTI’s own engineering firm, Keystone Experts & Engineers, later acknowledged that tree damage existed on the roof but refused to consider whether it was caused by Hurricane Ian. This selective application of facts demonstrates that PTI deliberately manipulated policy interpretations and ignored factual evidence to support its predetermined denial. PTI failed to conduct a reasonable and fair investigation before denying coverage by issuing a blanket denial of the claim without objectively analyzing whether Hurricane Ian contributed to the damages. Instead of performing a comprehensive structural damage assessment, PTI’s adjuster focused on pre-existing wear and tear without explaining how the storm may have worsened or accelerated the condition of the roof. This failure to consider alternative causes violates Florida law, which requires insurers to conduct a fair, objective, and good-faith assessment of all possible sources of damage before issuing a denial. Additionally, PTI refused to re-evaluate its position even after the insured presented additional documentation and hired a public adjuster, demonstrating its unwillingness to conduct a fair reassessment of the claim. PTI knowingly undervalued the claim and refused to negotiate in good faith by offering a preposterously low $100.00 settlement despite clear evidence of substantial storm-related damage. Following the insured’s Notice of Intent to Initiate Litigation (NOI) filed on August 29, 2024, PTI had an opportunity to reconsider its coverage determination and provide a reasonable settlement offer. Instead, PTI doubled down on its denial, hired a biased engineering firm, and used Keystone’s findings as a basis to reaffirm its refusal to pay. The fact that PTI offered only $100.00 as a resolution—despite the insured’s public adjuster providing a detailed estimate of $69,495.00—demonstrates that PTI’s goal was not to settle fairly but rather to force the insured into an unfair compromise or abandon his claim altogether. This is a textbook example of bad-faith claims handling. PTI failed to acknowledge and promptly respond to communications regarding the claim, delaying resolution and frustrating the insured’s ability to obtain a fair settlement. When the insured’s attorney, Weisser, Elazar & Kantor, PLLC, submitted a Letter of Representation (LOR) on September 4, 2024, requesting a certified copy of the policy and clarification of the claim determination, PTI failed to provide a timely or substantive response. Likewise, PTI did not acknowledge key correspondence related to the NOI process, nor did it provide the insured with a clear and reasonable explanation for its denial within a timely manner. This failure to promptly communicate prolonged the insured’s financial hardship and obstructed his ability to resolve the claim efficiently. PTI refused to fairly evaluate the insured’s losses despite clear evidence of storm-related damage by relying on biased experts, disregarding key documentation, and applying exclusions without fully investigating their relevance to the claim. When PTI retained Keystone Experts & Engineers for a joint reinspection on September 6, 2024, the firm’s primary objective was not to determine the truth but to validate PTI’s prior denial. Keystone’s engineers acknowledged that tree damage was present on the roof but refused to evaluate whether Hurricane Ian’s winds contributed to or caused this damage. This omission shows that Keystone’s role was not to conduct an independent assessment but rather to craft a report that would justify PTI’s refusal to pay. Furthermore, PTI’s engineers did not conduct a detailed meteorological analysis to determine wind speeds at the insured’s location on the date of loss. Had PTI fairly evaluated the claim, it would have considered whether the storm contributed to structural vulnerabilities in the roof, rather than dismissing the damage as purely pre-existing. PTI had ample opportunity to adjust and settle this claim in good faith, yet it chose to engage in deceptive practices, retain biased engineering firms, and manufacture coverage exclusions to justify its refusal to pay. After receiving notice of the loss, PTI had multiple points at which it could have engaged in an open, good-faith evaluation of the damages. Instead, PTI’s claims handling process was designed to deny, delay, and underpay. By cherry-picking evidence, selectively applying policy exclusions, and ignoring critical storm-related data, PTI intentionally obstructed the insured’s right to recovery. This bad-faith conduct violated industry standards, consumer protection laws, and the insurer’s contractual obligations. As a direct result of PTI’s actions, the insured has suffered significant financial hardship, stress, and unnecessary delays. The insurer’s refusal to acknowledge storm-related damage has left the insured unable to perform necessary repairs, exposing his property to ongoing deterioration. Furthermore, the insured has had to incur out-of-pocket costs, legal fees, and mitigation expenses that should have been covered under the policy. The insured faithfully paid his premiums to PTI with the expectation that his coverage would protect him in the event of a catastrophe. However, instead of honoring that promise, PTI engaged in a deliberate and systematic effort to deny his rightful benefits. PTI’s bad-faith handling of this claim constitutes a direct violation of Florida law and industry best practices. Its refusal to acknowledge storm-related damage, reliance on biased inspections, misrepresentation of policy terms, and failure to communicate with the insured have all contributed to unnecessary financial hardship and prolonged suffering for the policyholder. These actions not only warrant full payment of the claim but also potential legal penalties for PTI’s blatant violations of consumer protection statutes. PTI had ample opportunity to adjust and settle this claim in good faith, yet it chose to engage in deceptive practices, retain biased engineering firms, and manufacture coverage exclusions to justify its refusal to pay. The insurer’s actions have caused undue financial hardship, stress, and unnecessary delays for the insured, who has been left without the ability to properly repair his home despite having faithfully paid his insurance premiums. To cure these violations and act in good faith, PTI must tender full payment in the amount of $69,495.00, which represents the cost of necessary repairs based on an independent assessment. PTI must also issue a written acknowledgment that its denial was improper, revise its claim-handling procedures, and ensure that future claims are investigated thoroughly and impartially. If PTI fails to comply within sixty (60) days, the insured will proceed with litigation to seek damages for bad-faith claim practices, breach of contract, and all applicable attorney’s fees and costs. PTI’s handling of this claim has been marked by delay, misrepresentation, and a blatant disregard for the insured’s rights. This Civil Remedy Notice serves as a final opportunity for PTI to rectify its bad-faith conduct and fulfill its contractual obligations under the policy.
Comments
User Id Date Added Comment
bfrankel@gmail.com 05-13-2025 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed by Insured, Edwar Omar Aguilera Gonzalez (“Insured”) with filing number 811836. In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. The CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information the department may require: (1) The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. (2) The facts and circumstances giving rise to the violation. (3) The name of any individual involved in the violation. (4) Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. (5) A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. The instant CRN fails to include necessary facts that provide context to their statutory allegations aside from broad accusations and conclusions without any factual support. Notwithstanding, to comply with statutory obligations, PTI provides the following summary of facts in support of its categorical denial of every alleged statutory violation raised in this CRN. In short, PTI implemented compliant standards for investigating claims—including performing reasonable investigations, accurately representing facts and policy provisions, acknowledging and promptly acting upon communications from and on behalf of its policyholders, promptly advising when additional information is needed and why, and setting forth in writing detailed policy grounds supporting its coverage decisions. PTI implemented those standards as a general practice and fully adhered to them while adjusting this Claim. In light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted properly while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insured’s CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes. On 06/06/2024, a claim was reported on behalf of the Insured by a representative from Integrity Claims Group who called to report storm damage to the Insured’s property caused by Hurricane Ian on 09/28/2022. Per the initial report by Integrity Claims Group, the Insured’s roof has missing shingles which caused the roof to leak in the living room resulting in water damage to the ceiling and walls. Per the report, the damage to the ceiling consists of water stains and cracks. The representative further advised that the roof was tarped by JD Restoration and advised that no roofer has been contacted but he believes the Insured has done a few repairs himself but did not have further information. Following the reporting of the loss, on 06/18/2024, PTI’s Field Adjuster visited the subject property to perform the initial inspection and to determine the cause of loss and scope of damages. On 06/25/2024, PTI issued its written coverage denial letter setting forth the policy language and factual grounds upon which the decision was made. PTI denied the loss, in sum, because the inspection of the property determined that there was no evidence of wind or hail damage to the roofing system, nor any storm created opening to the dwelling. Rather, the inspection of the roof revealed age-related deterioration with heavy granular loss, mechanical damage, and prior repairs. The coverage denial letter explains that the Insured’s policy does not provide coverage for interior damage caused by rainwater intrusion unless a covered peril first damages the building causing an opening in a roof or wall and the rain enters through this opening, and that the policy does not provide coverage for age-related wear & tear, deterioration, and mechanical damage. Based on these observations, coverage was denied for the Insured’s claim. Subsequently, on 08/29/2024, the Insured, through counsel, submitted a Property Insurance Notice of Intent to Initiate Litigation. In response, on 08/30/2024, PTI requested a joint re-inspection of the Insured’s property with an engineer. On 09/06/2024, Keystone Experts and Engineers, LLC (Keystone) performed a re-inspection of the Insured’s property. Following the re-inspection, Keystone drafted a report that was provided to Insured. Specifically, Keystone determined that there was no wind or wind-borne debris damage to the roof covering. Further, Keystone did not observe and was not presented with evidence of storm-created openings, or creased or torn shingles. Keystone also determined that the roof covering exhibited aging and weathering-related deterioration, including significant granule loss, edge wear, and tree rub. Additionally, Keystone determined that the moisture stains in the front porch, living room, kitchen, and dining room were due to water infiltration through pre-existing openings in the roofing and flashing materials at the north slope that developed prior to reported date of loss and that deficient repairs made prior to Hurricane Ian were a contributing factor. Further, Keystone determined that moisture-stained finishes in the family room ceiling were the result of water infiltration through prior deficient repairs in the roofing and flashing materials on the low-sloped roof and that those deficiencies developed prior to the reported date of loss. On 09/11/2024, PTI reiterated its coverage denial to the Insured based in part on the findings of Keystone’s re-inspection. PTI specifically denies any and all allegations contained within the CRN including, but not limited to, those allegations contained within “Reason for Notice” including any claim for bad faith. Regarding the “Reason for Notice” of “Claim Denial” “Unsatisfactory Settlement Offer” and “Unfair Trade Practice”, PTI emphasizes that made its coverage determination after a thorough investigation of the loss including an inspection by a field adjuster and later conducted a re-inspection by an engineer. Regarding the “Reason for Notice” of “Claim Delay”, PTI first emphasizes that the claim was reported 617 days after the alleged date of loss. Additionally, PTI emphasizes that upon receipt of the reported claim, PTI had an inspection of the property performed by its field adjuster on 06/18/2024 and issued the coverage denial letter on 06/25/2024. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law. The CRN does not provide information to support the “Reason for Notice” and fails to include necessary facts that provide context to their statutory allegations aside from broad accusations and conclusions without any factual support. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. Regarding the allegations that PTI has failed to provide a copy of the policy, PTI denies said allegations as a certified copy was provided. Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies of all the statutory violations alleged in the Insured’s CRN. 1) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 2) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 3) ALLEGED VIOLATION §626.9541 (1)(i)(1) - Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts which have not been provided. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 4) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts which have not been provided. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 5) ALLEGED VIOLATION §626.9541 (1)(i)(3)(a) – Failing to adopt and implement stands for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. As the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. As described above, PTI’s investigation of this claim included an inspection by a field adjuster, and later a re-inspection by an engineer. 6) ALLEGED VIOLATION §626.9541 (1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. RESPONSE The Insured does not indicate what facts and/or policy provisions were misrepresented. Hence, PTI denies this alleged statutory violation. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 7) ALLEGED VIOLATION §626.9541 (1)(i)(3)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. PTI responded to communications including providing a certified copy of the policy and the coverage denial letter. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 8) ALLEGED VIOLATION §626.9541 (1)(i)(3)(d) – Denying claims without conducting reasonable investigations based upon available information. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. The CRN fails to provide specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate. 9) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 10) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. 11) ALLEGED VIOLATION §626.9541 (1)(i)(3)(g) – Failing to promptly notify the insured of any additional information necessary for the processing of a claim. RESPONSE PTI denies this alleged statutory violation and advises that Claimant has not provided any facts to sustain such an allegation. This loss at issue was timely investigated and denied under the terms, conditions, and exclusions of the subject policy and a detailed letter explaining PTI’s decision was provided to the Insured. CONCLUSION /SUMMATION The CRN broadly, vaguely and without evidence, alleges unsupported false allegations of statutory violations and tracks, in generalities and conclusions only, the language of numerous sections of Florida’s Civil Remedy Statutes without connecting the purported statutory violations to the facts of the claim and the history of the claims investigation. Moreover, the CRN also fails to include specific policy language relevant to the violation(s). In response to these very general allegations, and to comply with its statutory obligations, PTI responds by denying each and every allegation of misconduct asserted in the CRN, whether expressed and or implied, and by categorically denying each and every alleged statutory violation.   PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. As always, PTI is willing to consider any additional information the Insured can provide in support of their claim. We trust the foregoing fully explains the facts and circumstances of the claim and addresses any concerns raised. If we can provide other information or clarification of information in the claim, please do not hesitate to contact the undersigned. Thank you for your attention to this matter. Sincerely, Alexander S. Beck, Esq. abeck@pti.insure Tel: 561-609-1209 Litigation Counsel People’s Trust Insurance Company
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