People's Trust: Helene shed, siding, and downspout written off as wear

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 on behalf of its Insured, [name redacted] ("Insured").

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.

To be more specific, 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.

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 property and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insureds' 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. ?

1) On 10/3/2024, the Insured, Lisa [name redacted] called to report shingles blown off her roof. Per the Insured, there were no other damages, no repairs had been performed, and the roof was 15 years old. Subsequently, on 10/14/2024, PTI's Field Adjuster inspected the home in order to determine the cause of loss and scope of damages. At the time of the inspection, the Insured's mother was present and stated that the wood fencing was blown over by the wind, and that shingles were missing on the roofing system. There was no inspection of the interior due to PTI's Field Adjuster being informed there was no interior damage and therefore no need to inspect. As it relates to the roof, the inspection revealed wind damage, but no loss related damage was observed to the rear flat patio roof.

2) On 10/28/2024, a Coverage Determination letter was issued to the Insured acknowledging coverage for damages related to the roofing system, and excluding damage to the right elevation downspout, siding and shed as it was determined that those damages resulted from wear, tear, deterioration and mechanical damage. As for the exterior fence, the letter explained that while it did have wind damage it is excluded under the hurricane exclusion portion of the policy. The letter further explained that PTI was issuing payment for the covered damages measured at Actual Cash Value but the Insured could submit documentation of incurred costs to receive an additional payment for withheld depreciation, bringing the payment to Replacement Cost Value.

3) A few weeks later, on 11/8/2024, PTI received a Letter of Representation from Krapf Legal ("Insureds' Attorney"), which was acknowledged on 11/12/2024 at which time PTI requested all estimates, invoices, documents, and photographs related to the claim for damages, as well as submission of a Sworn proof of Loss and supporting estimate. Thereafter, a certified copy of the policy was sent to Insureds' Attorney on 12/2/2024.

As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law, and has not engaged in any actions listed under "reasons for notice," which include claim denial, claim delay, misrepresenting terms of the policy, inadequate/improper investigation, and unfair trade practice. Specifically, the CRN references no specific policy language relevant to the alleged violations and admittedly states that the violations alleged are statutorily based and do not rely on any specific policy language. In response thereto, PTI advises that coverage was acknowledged in this matter, PTI paid the full amount of damages as assessed by its Field Adjuster as covered under the policy, and that said payment was issued in accordance with the Loss Settlement provision of the policy. Moreover, the loss settlement provision states that the initial payment is measured at actual cash value and upon receipt of expenses incurred PTI will issue additional payment for withheld depreciation. To date, the Insured has not submitted proof of any incurred expenses that would warrant additional payment under the policy.

As it relates to claim delay, PTI specifically denies this allegation as the timeline of events details how PTI promptly and timely investigated the subject claim and responded to correspondence and documents submitted by and on behalf of the Insured. As it relates to allegations concerning the Insureds disagreement with the coverage decision, PTI advises that it issued full payment in accordance with the assessment by its Field Adjuster and in line with the policy, and no proof of incurred expenses has been submitted that would warrant additional payment. While the CRN mentions an estimate prepared by a roofing contractor on the Insureds behalf, PTI has no documentation relating to this valuation. As it relates to unfair trade practice, the CRN does not provide any information in support of this and therefore PTI denies said allegations. 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.

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 Claimants have not provided any facts to sustain such an allegation. PTI accepted coverage and provided the Insured with PTI's estimate and scope of repairs supporting the ACV undisputed payment issued on 10/28/2024.

2) ALLEGED VIOLATION

§626.9541(1)(i)(2) - A material misrepresentation made to an insured or any other 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 contact or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.

RESPONSE

The Insured does not indicate what facts and/or policy provisions were misrepresented. In fact, the CRN states the following: "the violations alleged are statutorily based and do not rely on any specific policy language…". Hence, PTI denies this alleged statutory violation.

3) ALLEGED VIOLATION

§626.9541 (1)(i)(3)(a) - Failing to adopt and implement standards 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. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006)

As mentioned above, PTI issued a coverage determination letter on 10/28/2024. Within the letter, the Insured was advised that coverage was being afforded for the claim and that a payment of $6,332.08 under Coverage A and would be issued. This payment reflected the Actual Cash Value of the damages to the dwelling.

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.

4) 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. In fact, the CRN states the following: "the violations alleged are statutorily based and do not rely on any specific policy language…". Hence, PTI denies this alleged statutory violation.

5) 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 Claimants have not provided any facts to sustain such an allegation. As mentioned above, the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented. Furthermore, PTI promptly investigated the claim, and a favorable coverage decision was made within 14 days after the post-loss property inspection.

6) 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 Claimants have not provided any facts to sustain such an allegation. PTI issued a coverage determination letter on 10/28/2024. Within the letter, the Insured was advised that coverage was being afforded for the claim and PTI was issuing loss payment in accordance with the itemized estimate describing the work needed to return the home to pre-loss condition and that said payment was measured at actual cash value in accordance with the policy at issue. The letter also cited to the relevant portion of the applicable policy and advised the Insured to submit documentation showing incurred expenses in order to obtain additional payment for the withheld depreciation and bring the payment to replacement cost value.

CONCLUSION /SUMMATION

In sum, PTI timely accepted coverage under Florida law and maintains that all alleged violations of Florida Statutes in this CRN are baseless, and the CRN offers no facts in support of the statutory violations alleged. In fact, the CRN broadly, vaguely and without a scintilla of evidence, alleges boilerplate, 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 Insureds 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.

Very truly yours,

/S/ [name redacted] Esq. Corporate Counsel People's Trust Insurance Company

Cc: [name redacted] Krapf, Esq. [address redacted] Clearwater, FL 33759 E-mail:

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.