Civil Remedy Notice of Insurer Violations
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Filing Number:     825285
Filing Accepted:  6/4/2025
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Complainant
Last/Business Name *  
LAKE TARPON SAIL & TENNIS CLUB COMMON ELEMENTS ASSOCIATION, LLC   First Name  
Street Address * 90 S. HIGHLAND AVENUE
City, State Zip * TARPON SPRINGS, FL 34689
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   LAKE TARPON SAIL & TENNIS CLUB COMMON ELEMENTS ASSOCIATION, LLC   First Name  
Policy # * VAVE0001448 Claim #* 77873 RRI
Attorney
Attorney is Applicable
Last Name* DANIELS First Name * MONICA Initial
Street Address* 560 VILLAGE BOULEVARD, SUITE 110
City, State Zip* WEST PALM BEACH , FLORIDA 33409
Email Address * MDANIELS@THEDANIELS-LAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNDERWRITERS AT LLOYD'S, LONDON
NAIC Company Code
 
Name of individual responsible for violation (if any):* RICHARD RICKETTS, AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM.
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)(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)(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.

COVERAGE A – Dwelling 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. 1. Covered Property Covered Property, as used in this Coverage Part, means the type of property described in this section, A.1., and limited in A.2. Property Not Covered, if a Limit Of Insurance is shown in the Declarations for that type of property. a. Building, meaning the building or structure described in the Declarations, including: 4. Loss Payment a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged property; (2) Pay the cost of repairing or replacing the lost or damaged property, subject to b. below; (3) Take all or any part of the property at an agreed or appraised value; or (4) Repair, rebuild or replace the property with other property of like kind and quality, subject to b. below. We will determine the value of lost or damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of the Valuation Condition in this Coverage Form or any applicable provision which amends or supersedes the Valuation Condition.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Lake Tarpon Sail & Tennis Club Common Elements Association, LLC (the “Insured”) purchased an insurance policy from Underwriters of Lloyd’s, London (“Insurer”), with Policy number VAVE0001448 (the “Policy”), to cover property located at 90 S. Highland Avenue, Tarpon Springs, Florida 34689 (the “Property”). On or August 5, 2024, the Property sustained damage due to Hurricane Debby, which caused extensive damage to the Property. The Insured promptly reported the loss to Insurer, mitigated the damages, complied with all applicable post-loss obligations, and retained a public adjuster to assist through this difficult time. The Insurer acknowledged the loss and assigned claim number 77873 RRI (the “Claim”) as well as claims representative Richard Ricketts from Blair and Company The Insured’s public adjuster provided the Insurer with an estimate the damages, photographs of the damage, a signed proof of loss, documents relating to the mitigation efforts, opened the Property for inspection, and complied with all of the Insurer’s requests for information and documentation. The Insurer went on to deny coverage on the Insured’s damages despite clear indications that these damages were ensuing from roof openings. Without sufficient funds to repair his property, the Insured may continue to suffer additional damages. The Insured was forced to retain legal counsel as it became clear that the Insurer was subverting its obligation to make the Insured whole. The Insurer’s refusal to properly investigate, adjust and fully compensate the Insured for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insured’s claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3). The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insured. The Insurer’s actions amount to, but are not limited to: A. “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 and with due regard for her or his interests;” B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”; C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;” D. “Failing to adopt and implement standards for the proper investigation of claims;” E. Claim Delay; F. Unsatisfactory Settlement Offers; and G. Unfair Trade Practices. In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201: (3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. To summarize, the Insured is a dutiful customer who made it a priority to pay his insurance premiums and to ensure that in such an event as the one here, his property would be covered. The Insured timely filed a claim and fulfilled all post-loss obligations. Insurer acknowledged the loss, assigned a claim number, and then improperly evaluated the claim. Insurer has failed to provide the Insured with qualified representatives to ensure the claim was initially adjusted, evaluated, and paid properly. To deny the Insured the benefit of the bargain after he satisfied all obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insured when he most needed the insurance coverage he had paid for. Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insured upon demand. The Insurer’s refusal and/or failure to settle the insurance claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insured’s claim as it is required to do so by contract, in order to influence settlements. To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured; (2) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing for any and all mitigation services performed in connection with the loss; (3) ensure that payment made would be adequate to place the Insured back in his pre-loss condition, minus all appropriately applicable deductibles; and (4) reimburse the Insured’s attorney’s fees and costs, since the Insured was forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insured, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice, including but not limited to payment of policy limits should the Insured’s property become structurally unsound as a result of the Insurer’s refusal to adhere to the terms of its own policy. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
Comments
User Id Date Added Comment
roy.xiao@clydeco.us 07-28-2025 Please accept this as the response on behalf of Certain Underwriters at Lloyd's, London subscribing to Policy Number VAVE0001448 ("Underwriters") to the Civil Remedy Notice filed on behalf of Lake Tarpon Sail & Tennis Club Common Elements Assoc., Inc. ("Lake Tarpon"), bearing file number 825285 and dated June 4, 2025 ("CRN"). The content of this response was submitted separately via email to Lake Tarpon's counsel eduenas@thedaniels-lawgroup.com. The Policy: Underwriters subscribe to a commercial property policy of insurance issued to Lake Tarpon, bearing policy number VAVE0001448, for the January 13, 2024 to January 13, 2025 policy period (the "Policy"). The Policy is a written document, the terms and conditions of which speak for themselves. The Policy insured Lake Tarpon's property located at 90 S Highland Ave, Tarpon Springs, FL 34689 ("Property"). The Property consists of a two-story clubhouse at a condominium complex as well as certain business personal property contained therein. The Policy's schedule of covered property shows a limit of liability of $562,700 for Building coverage and a limit of liability of $25,000 for Business Personal Property coverage. The Policy is a named peril policy. Specifically, the schedule of covered property also shows that the covered "Cause[s] of Loss" for both Building and Business Personal Property coverage are "Basic Excluding Theft." The Loss and Investigation: Lake Tarpon claims to have suffered a loss resulting from Hurricane Debby, which impacted the property on or around August 5, 2024. Specifically, Lake Tarpon claims that the roof on the clubhouse was damaged and that there was water intrusion at the event space, gym and bathroom. After the loss, Underwriters retained James "Boyd" Brown of the independent adjusting firm Wheeler, Defusco & Associates ("Wheeler") to adjust the loss. Mr. Brown completed an initial walk-through with a representative of Lake Tarpon on August 15, 2024. Thereafter, Wheeler retained Donan to inspect the Property, to act as engineers and to determine whether the roof covering was damaged by hail and/or wind and the cause of the interior water intrusion at the Property. Donan performed an inspection on September 11, 2024. The inspection revealed that the roof was not hail- or wind-damaged and that there were no storm-created openings in the roof covering. The inspection further showed that one shingle was creased due to man-made damage and the modified bitumen seams were partially unsealed due to age-related deterioration. In addition, Donan opined that the reported water intrusion was caused by deferred maintenance and unrelated to hail or wind. The Policy's Building and Personal Property Coverage Form states, "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." The Policy's Causes of Loss – Basic Form states: *** A. Covered Causes Of Loss When Basic is shown in the Declarations, Covered Causes of Loss means the following: 1. Fire. 2. Lightning. 3. Explosion […] 4. Windstorm or Hail, but not including: a. Frost or cold weather; b. Ice (other than hail), snow or sleet, whether driven by wind or not; or c. Loss or damage to the interior of any building or structure, or the property inside the building or structure, caused by rain, snow, sand, or dust, whether driven by wind or not, unless the building or structure first sustains wind or hail damage to its roof or walls though which the rain, snow, sand or dust enters; or d. Loss or damage by hail to lawns, trees, shrubs or plants which are part of a vegetated roof. 5. Smoke […] 6. Aircraft or Vehicles […] 7. Riot or Civil Commotion […] 8. Vandalism, meaning willful and malicious damage to, or destruction of, the described property. 9. Sprinkler Leakage […] 10. Sinkhole Collapse […] 11. Volcanic Action […] *** Based on their inspection, Donan determined that the roof at the Property was not hail- or wind-damaged and that there were no storm-created openings in the roof covering. In addition, Donan opined that the reported water intrusion was caused by deferred maintenance and unrelated to hail or wind. Accordingly, the claimed damage was not caused by or resulting from any Covered Cause of Loss, and there is no coverage under the Policy because the insuring agreement is not triggered. In addition, the Policy also contains the following exclusionary language: *** 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); (2) Mudslide or mudflow; (3) Water that backs up or overflows or is otherwise discharged from a sewer, drain, sump, sump pump or related equipment; (4) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings; or (5) Waterborne material carried or otherwise moved by any of the water referred to in Paragraph (1), (3) or (4), or material carried or otherwise moved by mudslide or mudflow. This exclusion applies regardless of whether any of the above, in Paragraphs (1) through (5), is caused by an act of nature or is otherwise caused. An example of a situation to which this exclusion applies is the situation where a dam, levee, seawall or other boundary or containment system fails in whole or in part, for any reason, to contain the water. But if any of the above, in Paragraphs (1) through (5), results in fire, explosion or sprinkler leakage, we will pay for the loss or damage caused by that fire, explosion or sprinkler leakage (if sprinkler leakage is a Covered Cause of Loss). *** Donan's report indicated that Lake Tarpon was concerned that fungal growth on the gym floor was evidence of groundwater permeating through the concrete slab. For the reasons explained above, there is no coverage because the claimed damage was not caused by or resulting from any Covered Cause of Loss. However, to the extent that any damage being claimed was caused directly or indirectly by water which seeped through "Foundations, walls, floors or paved surfaces," "Basements," or "Doors, windows or other openings," coverage would be precluded pursuant to the exclusion identified above. The Policy also contains the following Endorsement: *** THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY VAVE C06 10 20 - PRE-EXISTING DAMAGE EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART We do not cover any loss or damage directly or indirectly caused by, resulting from or contributed to by any pre-existing building damage at the time of loss insured under this policy. The above exclusion shall automatically be removed upon: (i) the completion of all building repairs; and (ii) written evidence, signed by a licensed general contractor, stating that such building repairs have been completed. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED *** As noted above, Donan opined that certain conditions identified at the property (such as unsealed bitumen seams and the water intrusion at the event space, gym and bathroom) resulted from age-related deterioration and deferred maintenance, and pre-dated Hurricane Debby. Accordingly, coverage is also excluded pursuant to the above pre-existing damage exclusion. Finally, the Policy contains the following provision: *** MICROORGANISM EXCLUSION (Absolute) This Policy does not insure any loss, damage, claim, cost, expense or other sum directly or indirectly arising out of or relating to: mold, mildew, fungus, spores or other microorganism of any type, nature, or description, including but not limited to any substance whose presence poses an actual or potential threat to human health. This Exclusion applies regardless whether there is (i) any physical loss or damage to insured property; (ii) any insured peril or cause, whether or not contributing concurrently or in any sequence; (iii) any loss of use, occupancy, or functionality; or (iv) any action required, including but not limited to repair, replacement, removal, cleanup, abatement, disposal, relocation, or steps taken to address medical or legal concerns. This Exclusion replaces and supersedes any provision in the Policy that provides insurance, in whole or in part, for these matters. *** To the extent Lake Tarpon seeks coverage for damage, claim, cost, expense or other sum directly or indirectly arising out of or relating to mold, mildew, fungus, spores or other microorganism of any type, nature, or description, coverage would be precluded by the foregoing provision in the Policy. Accordingly, for the reasons set forth above, Underwriters' coverage position was properly based upon an application of the facts, developed through investigation, to the language of the Policy. Therefore, Underwriters' investigation of Lake Tarpon's claim was properly conducted in accordance with Florida law, including but not limited to Fla. Stat. § 624.155, Fla. Stat. § 626.9541 and Florida Administrative Code 69B-220.201. Curing the CRN: With respect to "cure," the CRN provides that Underwriters may cure the CRN by "tender[ing] all insurance monies due and owing to the Insured," "tender[ing] all insurance monies due and owing for any and all mitigation services performed in connection with the loss," "ensur[ing] that payment made would be adequate to place the Insured back in his pre-loss condition" and "reimburs[ing] the Insured's attorney's fees and costs[.]" As an initial matter, Underwriters have no coverage obligations under the Policy because, as referenced above, the insuring agreement in the Policy is not triggered and, in addition, multiple exclusions apply. Further, requiring payment of the attorney's fees allegedly incurred by Lake Tarpon is improper pursuant to Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1282 (Fla. 2000) ("The Court rejects as unsupported [insured's] contention that the insurer must not only pay the claim within the sixty-day window, but must also pay all compensatory damages that flow from any delay in settling the claim. Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands."). Accordingly, Lake Tarpon's proposed method of "cure" is not valid, and the CRN is deficient on its face, precluding any action against Underwriters under Section 624.155, Florida Statutes. The Civil Remedy Notice: The CRN alleges that Underwriters has violated seven (7) specific statutory provisions, including the following Florida Statutes Sections: 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) (Failing to promptly settle claims 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)(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)(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). Lake Tarpon has failed to state how Underwriters' alleged actions amount to violations of the cited provisions, particularly when the insuring agreement in the Policy is not triggered and multiple exclusions apply. Lake Tarpon does not address the fact that the insuring agreement is not triggered, nor does Lake Tarpon address the policy exclusions, though these issues were discussed in letters sent on behalf of Underwriters dated August 9, 2024, and October 4, 2024. Accordingly, based on the lack of information provided in the CRN and the inaccuracy of the allegations made in the CRN, Lake Tarpon has failed to perfect its right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, and cannot pursue the civil remedy authorized therein. Underwriters believe this letter is a sufficient response to the CRN but will supplement the response as necessary. Should Lake Tarpon and/or the Department require further evidence, elaboration, or clarification in the context of the CRN and this response, please do not hesitate to contact the undersigned on behalf of Underwriters. Thank you, Taylor Davis Taylor.Davis@clydeco.us 404-410-3156 Roy Xiao Roy.Xiao@clydeco.us 404-410-3168
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