Civil Remedy Notice of Insurer Violations
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Filing Number:     817379
Filing Accepted:  4/23/2025
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Complainant
Last/Business Name *  
TC TAMPA LLC   First Name  
Street Address * 1705 CLEARWATER LARGO ROAD
City, State Zip * CLEARWATER, FL 33756
Email Address * PLEADINGS@CLAIMSADVOCACYCENTER.COM
Complainant Type: * Insured
Insured
Last/Business Name*   TC TAMPA LLC   First Name  
Policy # * FSF1675870A 003 Claim #* KY24K3040653
Attorney
Attorney is Applicable
Last Name* NAIMY First Name * MICHAEL Initial R
Street Address* 517 SW 1ST AVENUE
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * PLEADINGS@CLAIMSADVOCACYCENTER.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   WESTCHESTER SURPLUS LINES INSURANCE COMPANY
NAIC Company Code 10172
 
Name of individual responsible for violation (if any):* INSURER THROUGH ITS EMPLOYEES AND AGENTS
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
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)(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.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SEE GENERALLY COVERAGE A AND LOSS PAYMENT PROVISIONS, IN ADDITION TO THE ABOVE FLORIDA STATUTORY DUTIES.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

1) FAILURE TO PAY THE CLAIM; 2) FAILURE TO PROMPTLY INVESTIGATE THE CLAIM; 3) FAILURE TO PROPERLY INVESTIGATE THE CLAIM; 4) FAILURE TO ADJUST THE LOSS; 5) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; 6) LOOKING FOR WAYS TO DENY COVERAGE, DELAY PAYMENT AND OTHERWISE “STONE WALL” CLAIM; 7) PLACING THE FINANCIAL INTEREST OF THE INSURER BEFORE THAT OF THE POLICY HOLDERS AND CLAIMANTS 8) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING SUPERVISION AND OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY INVESTIGATE, ADJUST AND PAY FULL BENEFITS AVAILABLE TO ALL BENEFICIARIES. THE INSURER MAY HAVE FAILED TO ADOPT PROPER STANDARDS OR INVESTIGATIONS AND ADJUSTMENTS OF LOSSES OR IS OTHRWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. Breach of contract; failure to pay covered loss; denial of claim; failure to properly evaluate loss; bad faith in claims handling. A copy of this Notice has been sent to claimant/insured (TC TAMPA LLC). THE INSURED DISCOVERED THE FOLLOWING DAMAGE: Wind and/or storm damage to the property as result of Hurricane Milton. Date of Loss: on or about October 9, 2024. THE INSURER WAS NOTIFIED UPON DISCOVERY OF DAMAGE TO THE PROPERTY. A PUBLIC ADJUSTER CONFIRMED THE STORM DAMAGE AND DETERMINED THE SEVERITY OF THE DAMAGE AND PROVIDED AN ESTIMATEOF THE COST. IT IS EVIDENT THAT THE INSURED PROPERTY SUFFERED A COVERED LOSS. HOWEVER, THE INSURER HAS IN BAD FAITH REFUSED TO PAY THE FAIR VALUE OF THE LOSS AND DENIED THE CLAIM.
Comments
User Id Date Added Comment
chad.pasternack@kennedyslaw.com 06-16-2025 Westchester Surplus Lines Insurance Company (“Westchester”) hereby responds to Civil Remedy Notice No. 817379 (“Notice”) filed by TC Tampa LLC (“TC Tampa”) in connection with claim number KY24K3040653 under policy number FSF1675870A 003. Westchester objects to the Notice as facially defective because it does not state with specificity the information required by Fla. Stat. Section 624.155(3)(b): (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; and (4) Reference to specific policy language that is relevant to the violation, if any. The Notice fails to comply with Section 624.155(3)(b), so the Notice is legally insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 879 (Fla. 4th DCA 2021). The Notice does not identify any individuals involved with the alleged violations. The Notice does not identify any specific policy language relevant to the alleged violations. Instead, the Notice ambiguously states: “see generally Coverage A and Loss Payment provisions.” However, the insurance policy does not have a “Coverage A.” With respect to the statutory provisions that TC Tampa contends that Westchester violated, the Notice alleges that Westchester violated Section 624.155(1)(b)(3), alleging that Westchester failed to settle a claim under one portion of the insurance policy in order to influence settlements under other portions of the insurance policy. The Notice, however, does not identify what coverages are at issue or how Westchester tried to influence settlements amongst the coverages. The Notice alleges that Westchester violated Section 626.9541(1)(i)(3)(b), alleging Westchester misrepresented pertinent facts or insurance policy provisions relating to coverages at issue. However, the Notice does not identify any misrepresentations made by Westchester. Likewise, the Notice alleges that Westchester violated Section 626.9541(1)(i)(3)(c), alleging that Westchester failed to acknowledge and act promptly upon communications with respect to the claim, but does not identify any communication that Westchester failed to acknowledge or act upon promptly. The Notice alleges that Westchester violated Section 626.9541(1)(i)(3)(h), alleging that Westchester failed to explain the nature of requested information and the reasons why such information was necessary, but the Notice does not identify any such request for information made by Westchester. Likewise, the Notice alleges that Westchester violated Section 626.9541(1)(i)(3)(g), alleging that Westchester failed to promptly notify the insured of any additional information necessary for the processing of the claim, but does not identify any untimely request for information by Westchester. For these reasons, the Notice is legally insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 879 (Fla. 4th DCA 2021). Notwithstanding that the Notice is legally insufficient, the facts and circumstances described in the Notice are inaccurate. Westchester issued a commercial insurance policy to TC Tampa bearing policy number FSF1675870A 003, with policy period of August 4, 2024 through August 4, 2025 (“Policy”). The Policy provides certain insurance coverage for the building located at 1705 Clearwater Largo Road, Clearwater, FL 33756 (“Property”). The Property has two tenants, 420X Smoke Shop located on the south side of the Property and The Ticket Clinic on the north side of the Property. The Policy states, in relevant part: This policy excludes any loss or damage directly or indirectly caused by, resulting from or contributed to by any pre-existing property damage at the time of loss. *** A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. *** A. Covered Causes Of Loss When Special is shown in the Declarations, Covered Causes of Loss means direct physical loss unless the loss is excluded or limited in this policy. B. Exclusions 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. g. Water (1) Flood, surface water, waves (including tidal wave and tsunami), tides, tidal water, overflow of any body of water, or spray from any of these, all whether or not driven by wind (including storm surge); (4) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (c) Doors, windows or other openings; or *** 2. We will not pay for loss or damage caused by or resulting from any of the following: d. (1) Wear and tear; (2) Rust or other corrosion, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; (4) Settling, cracking, shrinking or expansion; f. Continuous or repeated seepage or leakage of water, or the presence or condensation of humidity, moisture or vapor, that occurs over a period of 14 days or more. *** 3. We will not pay for loss or damage caused by or resulting from any of the following, 3.a. through 3.c. But if an excluded cause of loss that is listed in 3.a. through 3.c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. c. Faulty, inadequate or defective: (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property on or off the described premises. *** C. Limitations The following limitations apply to all policy forms and endorsements, unless otherwise stated: 1. We will not pay for loss of or damage to property, as described and limited in this section. In addition, we will not pay for any loss that is a consequence of loss or damage as described and limited in this section. c. The interior of any building or structure, or to personal property in the building or structure, caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters …. TC Tampa reported a claim for damage to the Property resulting from Hurricane Milton on October 9, 2024. Westchester engaged independent adjusting firm Crawford Global Technical Services, which assigned adjuster Robbie Maples. Mr. Maples inspected the Property on October 14, 2024. He observed minor water damage to the interior of the Property and no wind damage to the exterior. Westchester also engaged HKA Global LLC, which assigned engineer Carlos Turizo, to assist with determining the causes and scope of damage at the Property. He inspected the Property on November 5, 2024. During the inspection, the tenant of 420X Smoke Shop informed Mr. Turizo that water intrusion from Hurricane Milton stained the wall and the bottom of wood joists along the east wall of the Property, and the wood floor at the entrance of the building on the north side. Regarding the exterior of the Property, Mr. Turizo observed evidence of long-term water accumulation on the east side of the roof, which was algae-stained. Mr. Turizo also observed that this area of the roof is above the claimed interior damage on the east side of the Property. He concluded that this interior moisture damage was the result of leaks through a degraded and deteriorated roof membrane. Mr. Turizo further observed that the main entrance storefront bottom frame was unsealed and contained gaps through which wind-driven rain entered. Mr. Turizo did not observe any wind-related damage to the roof or exterior. Based on these findings, Westchester denied coverage. Westchester specifically denies each and every accusation of wrongful conduct made against it in the Notice. Should the Department require further evidence, elaboration, or clarification in the context of the Notice and this response, please do not hesitate to contact the undersigned.
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