A Civil Remedy Notice is a formal complaint filed against an insurance company with Florida's Department of Financial Services. Filing one is the step Florida law requires before a policyholder can sue an insurer for bad faith. It is a public record, and the insurer gets 60 days to fix the problem before that right opens up.
So this is the policyholder's side of a dispute, written by their side, and it is an allegation rather than a finding. The insurer answered it, and its answer is published below alongside the complaint. Read both. Names, addresses, and policy and claim numbers have been removed here; everything else is quoted from the filing.
| Who the filing is against | FIRST PROTECTIVE INSURANCE COMPANY (NAIC #10897) |
|---|---|
| Who filed it | The policyholder |
| Attorney of record | Jonathan O'Neil |
| Where the property is | Naples, Florida |
| When it was accepted by the state | December 18, 2024 |
| When the 60-day cure window closed | February 16, 2025 |
| Why, in the state’s own categories | Claim Delay, Unfair Trade Practice |
| Type of insurance | Residential Property & Casualty |
| Policy language at issue | SECTION I - PERILS INSURED AGAINST A. Coverage A - Dwelling And Coverage B - Other Structures 1. We insure for sudden and accidental physical loss to covered property described in Coverages A and B unless the loss is otherwise excluded or limited in this policy. **** B. Coverage C - Personal Property We insure for sudden and accidental direct physical loss to covered property described in Coverage C caused by any of the following perils unless the loss is otherwise excluded or limited in this policy . . . 2. Windstorm or hail **** [A]ny ensuing loss to property described in Coverages A and B not precluded by any other provision in this policy is covered. **** D. Coverage D - Loss of Use The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. [name redacted] Value and 3. Civil Authority [name redacted] below. **** E. Additional Coverages 1. Debris Removal. a. We will pay your reasonable expense for the removal of: (1) Debris of covered property if a Peril Insured Against that applies to the damaged property causes the loss; or (2) Ash, dust or particles from a volcanic eruption that has caused direct loss to a building or property contained in a building. This expense is included in the limit of liability that applies to the damaged property. If the amount to be paid for the actual damage to the property plus the debris removal expense is more than the limit of liability for the damaged property, an additional 5% of that limit is available for such expense. ***** 2. Reasonable Emergency Repairs. a. We will pay up to the greater of $3,000 or 1% of your Coverage A limit of liability for the reasonable costs incurred by you for necessary measures taken solely to protect covered property from further damage when the damage or loss is caused by a Peril Insured Against. **** 11. Ordinance Or Law. a; You may use up to the Ordinance or Law percentage shown on the Declarations for the increased costs you incur due to the enforcement of building, zoning, or land use ordinances or laws. This coverage applies if the enforcement is directly caused by the same insured loss and is a covered cause of loss. **** 13. "Fungi", Mold, Wet Or Dry Rot, Or Bacteria a. The amount shown in the Schedule above is the most we will pay for: (1) The total of all loss payable caused by "fungi", mold, wet or dry rot, or bacteria; (2) The cost to remove "fungi", mold, wet or dry rot, or bacteria from covered property; (3) The cost to tear out and replace any part of the building or other covered property as needed to gain access to the "fungi", mold, wet or dry rot, or bacteria; and (4) The cost of testing of air or property to confirm the absence, presence or level of "fungi", mold, wet or dry rot, or bacteria whether performed prior to, during or after removal, repair, restoration or replacement. The cost of such testing will be provided only to the extent that there is a reason to believe that there is the presence of "fungi", mold, wet or dry rot, or bacteria. **** Also refer to: Coverage A provision, coverage B provision, coverage C provision, coverage D provision, all additional coverages provisions, all coverages provided by endorsement or rider, the declarations page, loss payment or settlement provision, duties in event of loss policy provision, all terms and conditions of section I of the insurance policy, the insurance policy definitions section, the insurance policy's exclusion of coverage provisions, all insurance policy provisions that provide coverage to the insured property, and all policy provisions. |
| Did the insurer respond | Yes, on February 13, 2025 |
624.155(1)(a)(1) - violating 626.9541(1)(i) 626.9541(1)(a)(1) -- misrepresenting the terms of an insurance policy. 626.9541(1)(i) -- unfair claim settlement practices. Facts of the case: First Protective Insurance Company ("FRONTLINE") has committed the following in handling the insured's claim: 1) failure to pay benefits owed; 2) failure to act in due diligence and good faith to resolve claims; 3) placing the financial interest of the insurer before that of the policy holder and claimant; 4) failure to properly train, evaluate, and manage adjusters retained to represent the policies and procedures of FRONTLINE; 5) looking for ways to delay benefit payments and otherwise "low ball" or "stone wall" claims; 6) looking for ways to deny the insured's claim; 7) looking for ways to reduce recovery to the insured; 8) failure to perform a reasonable investigation; 9) misrepresenting Florida statutory provisions to its insured; 10) misrepresenting insurance policy provisions to the insured; 11) FRONTLINE has failed and refused to acknowledge coverage and promptly pay the benefits due and owed to the insured; 12) the reasons for this may be attributed to improper training, supervision, and/or motivation of outside adjusters and claims supervisors to promptly and fairly adjust and pay full benefits available to the insured. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because a proper investigation and full and prompt payment for the loss is not occurring. In Florida, the work of adjusting insurance claims engages the public trust. FRONTLINE has breached this duty by its adjustment of the insured's claim of loss. FRONTLINE has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in violations as set forth above. FRONTLINE has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured's insurance claim for damages. Despite the insured's timely notification to FRONTLINE of their insurance claim, FRONTLINE has failed and refused to acknowledge the covered loss and pay all amounts due and owing to the insured under the policy of insurance. FRONTLINE has failed to promptly settle the insured's insurance claim, when the obligation to settle the claim had become reasonably clear, under one portion of the insurance, in order to influence settlements under other portions of the insurance policy coverage. Despite the insured's pleas otherwise, FRONTLINE has failed and refused to acknowledge its obligation to tender all insurance proceed monies due and owing the insured or assist the insured in mitigation of the damages. In exchange for a premium paid by the insured, FRONTLINE issued the subject all-risk insurance policy which provided coverage for the insured property from July 6, 2022, through July 6, 2023 for "sudden and accidental physical loss to covered property described in Coverages A and B unless the loss is otherwise excluded or limited in this policy." As such, the subject all-risk Policy contains coverage for all direct physical losses to the insured property unless the loss is specifically and unambiguously excluded from coverage by the Policy. On or about September 28, 2022, the insured property suffered a windstorm loss as a result of Hurricane Ian, and the insured immediately submitted a claim to FRONTLINE for property damage, i.e., storm, wind, rain, and water intrusion damage throughout the insured property. Hence, the insured suffered a substantial loss regarding the real property and continue to suffer such loss. Having suffered such substantial damage, the insured promptly notified FRONTLINE of the loss in an effort to mitigate the current damage and prevent the exacerbation of any additional losses. The desired result did not follow. FRONTLINE since being presented the Insured's claim has misrepresented policy provisions to avoid paying the insured what they are owed under the policy. Ultimately, FRONTLINE has failed and refused to properly settle the insured's claim in good faith. The insured has requested that FRONTLINE conduct an investigation, admit coverage, and pay damages; FRONTLINE has failed and refused to do so. In short, FRONTLINE has failed to handle its insured's claim in good faith in violation of Fla. Stat. 624.155(1)(b)(1), 624.155(1)(b)(3), and 626.9541(1)(i). Based upon FRONTLINE's investigation and property inspection, which confirmed damage, FRONTLINE nevertheless sent correspondence to the insured dated July 19, 2023 and September 12, 2023, (signed by FRONTLINE's adjuster, [name redacted] (Fla. Adj. Lic. #P241178)) denying the claim and failing and refusing to issue payment. In regard to insurance contracts, a specific refusal to pay a claim is the breach which triggers the cause of action. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. FRONTLINE Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991) (finding that a breach of contract takes place at the moment the insurance company refuses to pay a claim). Therefore, FRONTLINE breached the Policy. Moreover, FRONTLINE's argued exclusions and/or limitations to coverage are devoid of anti-concurrent causation language. Thus, "coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause." Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694, 699 (Fla. 2016). In addition, under the Policy, any ensuing loss to property not excluded or excepted in this policy is covered. Hence, there are a myriad of coverages under the Policy that would provide coverage for the loss. Nevertheless, FRONTLINE failed and refused to acknowledge the covered loss and pay all amounts due and owing for the loss. Therefore, FRONTLINE breached the Policy. Questioning the propriety of FRONTLINE's coverage denial, and given the extensive nature of the physical damage, the insured retained a loss consultant, Coastal Claims Services, Inc. ("CCS"), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on its investigation, CCS determined that a windstorm (Hurricane Ian) on or about September 28, 2022, caused damage throughout the exterior of the insured property (particularly the roof warranting its replacement), creating openings which allowed wind and rain to intrude into the interior causing additional damage. Moreover, CCS determined that at least $90,152.17 worth of repairs would be required to return the property to its pre-loss condition as a result of the windstorm loss. Nevertheless, FRONTLINE failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, FRONTLINE breached the Policy. Thereafter, the Insured sent correspondence to FRONTLINE enclosing the supporting CCS report outlining the cause, scope, and cost of the loss along with other supporting documents and requested FRONTLINE to reconsider its coverage denial. On April 3, 2024 and July 19, 2024, FRONTLINE sent correspondence to the insured (signed by FRONTLINE's adjuster, [name redacted] (Fla. Adj. Lic. #P241178)) and summarily reaffirmed its unequivocal denial of coverage. Hence, FRONTLINE failed and refused to acknowledge the covered loss and pay all amounts due and owing for the loss. Therefore, FRONTLINE breached the Policy. On December 18, 2024, the insured sent correspondence to FRONTLINE enclosing the Sworn Statement in Proof of Loss, the supporting CCS report outlining the cause, scope, and cost of the loss along with other supporting documents, the Notice of Intent to Initiate Litigation, and requested FRONTLINE to reconsider its coverage denial. To date, FRONTLINE has failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, FRONTLINE breached the Policy. As such, FRONTLINE'S coverage denial is a blatant misrepresentation of the available coverages under the Policy in direct violation of Fla. Stats. 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is nothing more than a mere pretext to wrongfully deny and delay this claim. As a result, FRONTLINE has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of effecting settlement of the insured's claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Fla. Stat. § 626.9541(1)(i)(2). Further, FRONTLINE is in violation of Florida statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Fla. Stat. 626.9541(1)(i)(3)(d) by denying the insured's claim without conducting a reasonable investigation based upon available information. In summary, the insured's loss is clearly covered by the terms of the policy of insurance with FRONTLINE. However, FRONTLINE chose to deny coverage for the insured's loss. Despite clear evidence that the damage was covered and caused by a covered peril, the claim was denied. To date, FRONTLINE continues to deny the insured and its insured's full indemnity for the claim. While FRONTLINE refuses to honor this claim, a jury in Collier County will likely do what FRONTLINE has refused; exercise the benefit of doubt in favor of the insured in finding full coverage for this loss. Indeed, the insured will undoubtedly meet the burden of proof at trial, under the FRONTLINE all-risk policy, to show that, while FRONTLINE provided insurance coverage, damage occurred to the insured property. See Jones v. [name redacted] 'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). With the data presented within FRONTLINE's investigation and CCS's investigation, FRONTLINE's burden to demonstrate by the greater weight of the evidence that all the physical damage to the insured property was caused solely by excluded perils under the policy and not in combination with a covered peril has not and cannot be met. See Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694 (Fla. 2016). Despite clear indicators of covered damage, FRONTLINE nevertheless inexplicably denied the insured's claim. As of today, FRONTLINE has failed and refused to inform the insured of their rights under the policy of insurance and Florida statutes, has improperly delayed the insured's claim, has wrongfully denied the insured's claim, and has failed and refused to adequately indemnify the insured for the loss and defiantly continues to do so. Indeed, from the time of receiving the claim, FRONTLINE has purposely and maliciously delayed in adjusting the subject claim in an effort to either avoid paying the claim altogether or, at the very least, avoid paying the full extent of the loss. Notably, under Florida law, "[t]he filing of a lawsuit does not extinguish the insurer's obligations under the policy to adjust and pay the claim." [name redacted] Inc. V. Arch Specialty Ins. Co., 434 F. Supp. 2d 1286, 1289 (M.D. Fla. 2006). To date, the insured has made a good faith effort to comply with all of the requirements under the subject policy of insurance, and it is only fair that FRONTLINE do the same. Yet, that is not the case. The insured feel that the insured property is a valuable asset, and, by continuously delaying the proper handling of this claim, FRONTLINE is putting the insured property at risk. As responsible property owners, the insured purchased insurance to protect the property, paid all of the premiums, and have kept up to date with the responsibilities under the policy. Yet, when the insured needed to rely on the insurance because of this unforeseen loss, FRONTLINE turned its back and delayed and wrongfully denied coverage that the insured are rightfully owed. Ultimately, FRONTLINE has failed and refused to properly investigate the loss. The insured has requested that FRONTLINE admit coverage and pay damages, FRONTLINE has failed and refused to do so, and continues to refuse to fully indemnify the insured for the loss and pay the amounts necessary to properly repair the insured's property, despite knowing it is required to do so. In short, FRONTLINE has failed to handle its insured's claim in good faith. In Florida, the work of adjusting insurance claims engages the public trust; FRONTLINE has breached this duty by its insufficient adjustment of the insured's claim. FRONTLINE has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations set forth above. FRONTLINE has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured's insurance claim for damages. Florida statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate their damages to put them back into the position they were prior to loss as quickly as possible. FRONTLINE breached this duty. The actions taken by FRONTLINE in the handling / adjustment of the insured's claim were willful, wanton, and with complete disregard for the rights of its insured and occur with such a frequency as to indicate a general business practice and are in violation of Fla. Stat. 624.155 and 626.9541. FRONTLINE'S actions amount to but are not limited to the following:
1. Claim delay
2. Wrongful claim denial
3. Unfair trade practice
4. Unfair claim settlement practices
5. Unreasonable investigation
6. Failure to act on claim
7. Failure to conduct a reasonable investigation based on available information
8. Failure to maintain proper complaint handling procedures
9. Misrepresenting the insurance policy provisions to the insured 10. Misrepresenting Florida statutory provisions to the insured 11. Misrepresenting facts to the insured 12. Failure to acknowledge and act promptly upon communications with respect to claims 13. Denying claims without conducting reasonable investigations based upon available information 14. 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 [address redacted]atements have been completed. 15. 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. 16. Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 17. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 18. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. Therefore, to cure the defects outlined in this civil remedy notice, FRONTLINE must: (1): Admit full coverage for the insured's loss; and (2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy; A copy of this form submitted to the FDFS has been emailed and/or uploaded and also printed out and mailed to the following parties providing them notice of the filing of this civil remedy notice: First Protective Insurance Company [address redacted] [name redacted] FL 32795 [email redacted]
(1): Admit full coverage for the insured's loss; and (2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy;
These are the statutes named on the form. The wording under each is the statute's own, as the state prints it on the notice.
| 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)(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. |
| 626.9541(1)(i)(3)(h) | Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. |
| 626.9541(1)(i)(4) | Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). |
Filed with the state on February 13, 2025. This is the insurer's own written response to the complaint above, quoted from the same public record.
Florida DFS Civil Remedy Notice, filing number 797441. Read the filing on the state's site ↗
A Civil Remedy Notice records an allegation, not a finding. Nothing here has been decided by a court or by the Department. Not legal advice; consult an attorney about your specific claim.
Selected from the Civil Remedy Notices read for the archive as a documented example of a claim decided without a real inspection. The pattern page shows how often that argument appears and which carriers the filings name.
Fla. DFS Civil Remedy Notice, Filing No. 797441 (Naples), accepted 12/18/2024 · public record ↗
Quotes are verbatim from the cited public record. Case status and statute summaries drafted August 2026; verify against the current docket and statute. Not legal advice; consult an attorney about your specific claim.
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