Florida Peninsula: a $44,741 payment against a $267,527 documented loss

VIA DFS WEBSITE Florida Department of Insurance Civil Remedy Section [address redacted]reet Tallahassee, Florida 32399

Complainant: [name redacted] Claim no. [redacted] ("subject claim") Policy no. [redacted] ("policy") Loss Location: [address redacted] Bokeelia, FL ("property") CRN Filing No: 794809 CRN Acceptance Date: 12/2/2024

RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 794809

Dear Sir or Madam:

The undersigned counsel represents Florida Peninsula Insurance Company ("FPIC") in regard to the alleged dispute as to the subject claim number listed above involving an alleged windstorm with a date of loss of on or about September 28, 2022, made under the Policy of insurance FPIC issued to the complainants, [name redacted] . This correspondence constitutes Florida Peninsula Insurance Company's response to the Civil Remedy Notice of Insurer Violations ("Notice" or "CRN") filed on behalf of [name redacted] (referenced herein as "Insureds" or "Complainants") regarding the claim listed above. Based on the below response, the Civil Remedy Notice should be rejected and returned by the Department of Financial Services as it is substantively defective and objectionable for the reasons stated herein, and, without waiving objections, as it completely misstates the facts surrounding this claim.

ALLEGED STATUTORY VIOLATIONS

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. FPIC specifically denies the allegation that it has violated the above referenced statute. FPIC did not violate these provisions. The CRN does not include any facts to support this allegation. FPIC conducted thorough investigations in good faith and issued coverage determination accordingly. In fact, FPIC issued payment in excess of insured's actual cost to repair.

624.155(1)(b)(2): Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. FPIC specifically denies the allegation that it has violated the above referenced statute. FPIC did not violate these provisions. The CRN does not include any facts to support this allegation. FPIC conducted thorough investigations and issued coverage determination to include a detailed statement of loss under which payments were made.

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. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted thorough investigations in good faith and issued a coverage determination accordingly. In fact, FPIC issued payment in excess of insured's actual cost to repair.

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. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation.

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. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions and specifically has made no material misrepresentation regarding the policy or otherwise. The CRN does not include any facts to support this allegation. Florida Peninsula conducted thorough investigations in good faith and issued a coverage determination accordingly. In fact, FPIC issued payment in excess of insured's actual cost to repair.

626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Florida Peninsula specifically denies the Complainant's allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. [name redacted] did not fail to adopt and implement standards for the proper investigation of the claim.

626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula did not materially misrepresent anything to the Insured, or his representatives, as limiting coverage is not a material misrepresentation.

626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. FPIC specifically denies the allegation that it has violated the above referenced statute. FPIC did not violate these provisions. The CRN does not include any facts to support this allegation. FPIC promptly responded to all communications forwarded by insured and representatives and issued a prompt coverage determination in accordance with policy and investigation.

626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. The claim was not denied. Florida Peninsula conducted thorough investigations in good faith and issued its coverage determination based on the Policy's provisions, conditions, exclusions and endorsements.

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 [address redacted]atements have been completed. FPIC specifically denies the allegation that it has violated the above referenced statute. FPIC did not violate these provisions. The CRN does not include any facts to support this allegation. FPIC conducted thorough investigations and promptly issued coverage determination to include a detailed statement of loss under which payments were made.

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. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. The allegation is not relevant to the claim at issue as it was not denied. Florida Peninsula conducted thorough investigations in good faith and issued its coverage determination to include a detailed statement of loss under which payments were made.

626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted thorough investigations in good faith and communicated with the insured throughout relative to any need for additional information.

626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted thorough investigations in good faith and communicated with the insured throughout relative to any need for additional information.

626.9541(1)(i)(3)(i): Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. The allegation does not apply as the subject claim does not involve personal injury protection benefits. Accordingly, the CRN does not include any facts to support this allegation. Florida Peninsula conducted thorough investigations and issued timely payment per the relevant statute.

In addition to the allegations specifically denied above, FPIC denies all allegations presented in this CRN, as FPIC has not violated any statute, Code or Rule.

SPECIFICITY REQUIREMENTS

Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to "cure" the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the Insured's contentions, including but not limited to, those that would be necessary for FPIC to "cure" the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that FPIC could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So. 3d 875 (Fla. 4th DCA 2021). For the reasons set forth herein, FPIC hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate.

As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, the Insured failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them.

The Insured's failure to describe any actual facts or circumstances to support the alleged statutory violations in the CRN precludes FPIC from evaluating what error, if any, allegedly occurred during the claim process. Furthermore, contrary to the requirement to "describe the facts and circumstances giving rise to the insurer's violation as you understand them at this time," the purpose of which is "to enable the insurer to investigate and resolve [the] claim," the CRN itself only provides unsupported and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and FPIC is unable to determine what specifically the Complainant is claiming was done by or on behalf of FPIC that constitutes the bad faith alleged.

Due to the absence of specific and accurate information regarding the alleged acts or omissions by FPIC which allegedly give rise to any violation of the Civil Remedy Statute, FPIC is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, FPIC explicitly denies violations of any applicable Florida Statute in the adjustment of the subject claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above. FPIC maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insured's claim. Further, FPIC wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the subject claim by FPIC.

Additionally, the CRN fails to state with specificity the facts relevant to any alleged policy violation. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). The CRN merely refers to general language without any details as to how any provisions were actually violated. Thus, the CRN does not satisfy the requirements.

BACKGROUND FACTS

Aside from the fact that the allegations contained in the subject CRN lack specific facts, the tenor and inferences of statutory violations are wholly without merit, and FPIC denies each and every one. Below are some of the relevant facts regarding the subject claim that the Insured failed to include in the CRN.

On October 4, 2022, Complainant contacted FPIC to report a claim for wind damages as a result of Hurricane Ian which occurred on September 28, 2022. As a result of the alleged loss, Complainant claimed leaking windows and doors, roof leaking, damaged siding, and worries of mold. No mitigation attempts had been made at the time of reporting. Immediately, that same day, Florida Peninsula sent correspondence acknowledging receipt of the claim.

Thereafter, FPIC inspected the loss via independent FA who observed some wind related damage to the roof, exterior wind damage to vinyl siding, soffit and gutters as well as some interior damage to ceilings in the living room, bedroom and kitchen. The FA took photos of the property and prepared an estimate for repairs to include roof replacement and interior repairs in the living room, bedroom, kitchens, foyer, living room, dining room, bedroom, hallway, both decks, exterior elevations and fencing.

On November 30, 2022 FPIC issued payment to the insured totaling $43,915.97 for Coverage A and $825.65 for Coverage B after application of the policy deductible and depreciation based on a total allowed amount of $51,792.76. The estimate and statement of loss were attached to the payment letter.

Thereafter, the Complainants forwarded an RCV estimate from his PA, [name redacted] Adjusting Services, for the same repairs totaling $267,527.11 which exceeded the policy limits. One year following the date of loss, a shrink wrap invoice dated September 26, 2023, was forwarded for payment, despite FPIC having issued payment for roof replacement ten (10) months prior.

The Complainant never forwarded any paid invoices or evidence of commencement of repairs.

A notice of intent to initiate litigation was forwarded to FPIC on October 27, 2023 seeking indemnity payments in excess of the full policy limit. FPIC responded on November 7, 2023 making an offer of additional payment to the Complainant despite his failure to commence repairs with the prior payment issued.

A lawsuit was filed by the Complainant in the Lee County Court on November 30, 2023. A public records search indicates that in June 2024, the Complainant completed roof replacement for $11,000 - $6,691.54 less than the $17,691.54 roof replacement amount allowed by FPIC. Accordingly, FPIC has issued payments to the Complainant in excess of the actual cost of repairs and nearly two years prior to the Complainant having ever attempted to make a repair.

FPIC conducted a good faith comprehensive and prompt investigation of this claim. FPIC consistently and promptly communicated with the Insureds and their representatives and conducted an inspection of the property. FPIC issued a coverage determination based on the inspection, investigation of the claim and policy provisions.

FPIC respectfully denies any wrongdoing in the adjustment and handling of the Subject Claim, and further denies any and all allegations that it violated any statutes. Instead, FPIC acted quickly and responsibly and in accordance with the terms and provisions of the applicable Policy of insurance as well as with F.S. §624.155 and §626.9541 and its sub-parts.

INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN

The case specific facts related to FPIC's handling of the subject claim provided above implicitly address many of the vague allegations contained within the Insured's CRN and further establish that FPIC undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. It is important to note that the Insured has not provided any factual support for any of the above allegations. Instead, the facts support that FPIC promptly contacted the Insured, inspected the claim shortly after it was reported, and issued a coverage determination based on a thorough investigation. The circumstances support that FPIC conducted a good faith, thorough, prompt investigation with the information provided. The Insured is alleging bad faith in a scenario where FPIC conducted a comprehensive, prompt investigation in good faith and issued payments in excess of the Complainant's incurred expenses.

Furthermore, contrary to the requirement to "describe the facts and circumstances giving rise to the insurer's violation as you understand them at this time", the purpose of which is "to enable the insurer to investigate and resolve [the] claim", the Civil Remedy Notice itself only provides completely false allegations with no basis in fact or circumstances. This CRN is simply based on a matter where the Insured disagrees with the amount of damage determined by FPIC.

As clearly set forth above and contrary to the allegations set forth in the Notice, FPIC's investigations and adjusting of its Insured's claim were prompt, thorough, and complete. Furthermore, the Insured has included absolutely no facts or evidence to support any claims in the Notice. All of these baseless claims support FPIC's position that the claim was properly adjusted, and the Insured does not actually have any concrete facts to support a bad faith allegation.

As mentioned, mere disagreement as to coverage does not equate to bad faith. The Civil Remedy Notice does not show how FPIC has failed to comply with the statutory provisions alleged to have been violated. Evidently, this Civil Remedy Notice was filed in bad faith, as it is being used as an improper mechanism designed solely for the purpose of intimidating FPIC into potentially overpaying the Insured. For the aforementioned reasons, FPIC categorically denies that it has acted with bad faith in connection with this claim.

CONCLUSION

The purpose of a CRN is to provide the insurer an opportunity to "cure" the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how FPIC can "cure" the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005).

Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows:

Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996).

Here, FPIC properly issued coverage determination for the subject claim as it investigated the loss within the statutory time limit. FPIC denies all of the allegations contained in the subject CRN, which is defective and improper, as FPIC has not violated any of the subject statutes. FPIC further states that the accusations made against it in the subject CRN are patently false.

In closing, FPIC first believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law. Due to the lack of any factual and circumstantial basis to support the allegations therein, FPIC respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, FPIC denies all allegations contained in the Civil Remedy Notice and submits there are no violations.

While FPIC's response herein is meant to address the allegations in the Insured's Notice, it is based upon the limited information provided in the Civil Remedy Notice and the information presented to date. If the Complainant feels that FPIC is not in possession of all the facts, please inform the undersigned immediately. Please note that FPIC's response is not necessarily exhaustive and does not preclude FPIC or anyone on FPIC's behalf from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of FPIC or any agent or representative of FPIC should not be construed as a waiver of any rights or defenses available to it by contract or at law, as all such rights and defenses are hereby specifically reserved.

On behalf of FPIC, we trust that this response addresses the allegations in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned.

[name redacted] Yours,

QUINTAIROS, PRIETO, WOOD & BOYER, P.A.

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.