Insurance DOI Complaint and Bad-Faith Demand — Florida

Insurance DOI Complaint and Bad-Faith Demand (Florida)

Quick-Reference Summary

Part A — DFS Consumer Complaint Cover Letter

Letterhead

[Sender Law Firm Name]
[________________________________]
[________________________________]
[City], FL [Zip Code]
Phone: [________________________________]
Email: [________________________________]
Florida Bar No.: [________________________________]

Date and Recipient

Date: [__/__/____]

VIA DFS CONSUMER ASSISTANCE PORTAL AND U.S. MAIL
DFS Confirmation No.: [________________________________]

Florida Department of Financial Services
Division of Consumer Services
200 East Gaines Street
Tallahassee, FL 32399-0322

Subject Line

RE: CONSUMER COMPLAINT — UNFAIR CLAIMS SETTLEMENT PRACTICES BY [CARRIER LEGAL NAME] (NAIC # [____]) — POLICY NO. [________] — CLAIM NO. [________]

I. Insured Information

II. Carrier and Policy Information

III. Claim Background

Date of Loss: [__/__/____]
Claim Number: [________________________________]
Date Reported: [__/__/____]
Amount Demanded: $[________________________________]
Amount Paid To Date: $[________________________________]
CRN Filed? ☐ Yes (CRN No. [________], filed [__/__/____]) ☐ No
NOIITL Filed? ☐ Yes (filed [__/__/____]) ☐ N/A

Summary of Loss:

[________________________________]
[________________________________]

IV. Specific Unfair Practices Alleged

The conduct of [Carrier] violates Fla. Stat. §§ 626.9541(1)(i) and 626.9541(1)(o), and the statutory deadlines of Fla. Stat. § 627.70131:

☐ § 626.9541(1)(i)(3)(a) — Failing to acknowledge and act promptly upon communications.
☐ § 626.9541(1)(i)(3)(b) — Failing to adopt and implement standards for proper investigation.
☐ § 626.9541(1)(i)(3)(c) — Denying claims without conducting reasonable investigations.
☐ § 626.9541(1)(i)(3)(d) — Failing to affirm or deny full or partial coverage within 30 days after proof of loss.
☐ § 626.9541(1)(i)(3)(f) — Failing to promptly notify the insured of any additional information necessary to process the claim.
☐ § 626.9541(1)(i)(3)(h) — Failing to provide a reasonable explanation of policy provisions on which denial is based.
☐ § 627.70131(5)(a) — Failure to pay or deny within 60 days (residential property; tolled by allowable extensions) — subject to 90-day rule in effect for the loss date.
☐ § 627.70131(1)(a) — Failure to acknowledge claim communications within 7 days.
☐ § 624.155(1)(b)(1) — Not attempting in good faith to settle claims when, under the circumstances, the insurer could and should have done so had it acted fairly and honestly toward its insured and with due regard for her or his interests.
☐ Other [________________________________]

Factual basis: [________________________________]

V. Documents Enclosed

☐ Declarations page and full policy
☐ Sworn proof of loss
☐ Claim notification correspondence
☐ Carrier acknowledgment, ROR, and denial letters
☐ Estimates, photographs, expert reports
☐ Adjuster communications
☐ Civil Remedy Notice (CRN) confirmation, if applicable
☐ § 627.70152 Notice of Intent (if property claim)
☐ Demand letter to carrier (Part B)
☐ Written authorization (Section VII)

VI. Requested DFS Action

1. Open formal complaint file and assign an investigator.
2. Forward to OIR Market Investigations if pattern conduct is suspected.
3. Refer to Office of Insurance Regulation Enforcement for administrative penalties under Fla. Stat. §§ 624.418 / 626.9521.
4. Provide a copy of all carrier responses and closing letter.

VII. Authorization

Insured authorizes [Carrier] to release to DFS all records concerning Policy No. [________] and Claim No. [________], including claim notes, recorded statements, reserves, vendor reports, and internal communications.

Insured Signature: [________________________________]
Date: [__/__/____]

Signature Block

[________________________________]
[Attorney Name], Fla. Bar No. [________]
[Law Firm]
Attorney for Insured

cc: [Carrier — Claims Department]
cc: Chief Financial Officer, as registered agent for service under Fla. Stat. § 624.422 (for noticing purposes only — not for SOP)

Part B — Bad-Faith Demand Letter and Civil Remedy Notice

Letterhead

[Sender Law Firm Name]
[Same as above]

Date and Recipient

Date: [__/__/____]

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
Certified Mail No.: [________________________________]
AND VIA EMAIL TO: [________________________________]

AND CIVIL REMEDY NOTICE FILED WITH FLORIDA DFS:
CRN Number: [________________________________]
Filed on: [__/__/____]

[Carrier Legal Name]
Attn: Claims Department — Bad-Faith / Coverage Counsel
[________________________________]
[City], [State] [Zip Code]

Subject / Re: Block

RE: STATUTORY CIVIL REMEDY NOTICE UNDER FLA. STAT. § 624.155 AND DEMAND FOR PAYMENT — 60-DAY CURE PERIOD COMMENCES ON DFS FILING DATE

Insured: [________________________________]
Policy Number: [________________________________]
Claim Number: [________________________________]
Date of Loss: [__/__/____]

I. Parties

Insured: [________________________________], a [resident / Florida entity] at [Address], Florida.

Carrier: [Carrier Legal Name], a [state] [corporation/insurer] authorized to write insurance in Florida; OIR Company Code [____]; NAIC [____].

II. Statement of Claim and Carrier Response History

Narrative of Facts and Circumstances Giving Rise to the Violation:

[________________________________]
[________________________________]

Individuals Involved (§ 624.155(3)(b)(3)): [Adjuster Name(s), Supervisor Name(s), Coverage Counsel]

III. Violations of the Florida Unfair Insurance Trade Practices Act

[Carrier]'s acts and omissions violate, at minimum:

☐ Fla. Stat. § 624.155(1)(b)(1) — Not attempting in good faith to settle claims when, under all the circumstances, the insurer could and should have done so had it acted fairly and honestly toward its insured and with due regard for her or his interests.
☐ Fla. Stat. § 624.155(1)(b)(2) — Making claims payments to insureds or beneficiaries not accompanied by a statement of coverage under which payments are made.
☐ Fla. Stat. § 624.155(1)(b)(3) — Failing to promptly settle claims when liability has become reasonably clear under one portion of the policy in order to influence settlements under other portions.
☐ Fla. Stat. § 626.9541(1)(i)(3) — [enumerated subsections from Part A.IV above]
☐ Fla. Stat. § 627.70131 — Acknowledgment, investigation, and payment deadlines

Specific Policy Language Implicated (§ 624.155(3)(b)(4)): [Cite policy section, e.g., "Section I — Property Coverages, Coverage A, Dwelling," "Loss Settlement clause," "Anti-Concurrent Cause endorsement"]

IV. Statutory Civil Remedy Basis

This notice is given to perfect the right to pursue the civil remedy authorized by Fla. Stat. § 624.155, in accordance with § 624.155(3)(b)(5). For third-party (failure-to-settle) liability, Insured/Claimant also relies on the common-law duties recognized in Boston Old Colony Ins. Co. v. Gutierrez, 386 So. 2d 783 (Fla. 1980), and Berges v. Infinity Ins. Co., 896 So. 2d 665 (Fla. 2004).

V. Civil Remedy Notice — 60-Day Cure Period

PURSUANT TO FLA. STAT. § 624.155(3)(c), [CARRIER] IS GIVEN SIXTY (60) DAYS FROM THE DATE OF FILING OF THIS CIVIL REMEDY NOTICE WITH THE FLORIDA DEPARTMENT OF FINANCIAL SERVICES TO PAY THE DAMAGES SET FORTH BELOW OR OTHERWISE CORRECT THE CIRCUMSTANCES GIVING RISE TO THE VIOLATIONS. PAYMENT OR CORRECTION WITHIN THE 60-DAY WINDOW WILL BAR ANY BAD-FAITH ACTION UNDER § 624.155.

CRN Filing Date: [__/__/____]
Cure Period Expires: [__/__/____]

VI. Demand for Payment / Specific Performance

To cure the violations, [Carrier] must, within the 60-day cure period:

1. Pay $[________________] in policy benefits;
2. Pay $[________________] in incidental and consequential damages;
3. Withdraw the denial / coverage position dated [__/__/____];
4. Produce the complete unredacted claim file;
5. Provide written confirmation that no claim-file documents have been destroyed.

VII. Damages Sought If Not Resolved

VIII. Litigation Hold / Evidence Preservation Notice

[Carrier] shall preserve all documents, ESI, recorded statements, claim file notes, reserve information, adjuster diary, supervisor notes, internal emails, IMs, training materials, claims-manual provisions in effect on the date of loss, reinsurance communications, vendor reports (engineers, contractors, IA, SIU, FRSF), and any communications concerning Insured. Florida recognizes a duty to preserve; spoliation may be addressed by sanctions and adverse inferences. See Martino v. Wal-Mart Stores, Inc., 908 So. 2d 342 (Fla. 2005).

IX. Response Deadline and Method

Respond in writing to undersigned counsel on or before [__/__/____] (60 days from CRN filing), by email and U.S. Mail. After the cure period expires without resolution, suit will be filed seeking the full scope of damages and fees set forth above.

Signature Block

Respectfully,

[________________________________]
[Attorney Name], Fla. Bar No. [________]
[Law Firm]
Attorney for Insured

Enclosures: Exhibit A — Policy; Exhibit B — Proof of loss; Exhibit C — Carrier denial; Exhibit D — Estimates / expert reports; Exhibit E — CRN confirmation page

Part C — Pre-Filing Checklist

☐ Civil Remedy Notice drafted and filed via DFS portal (apps.fldfs.com/CivilRemedy/)
☐ CRN cites specific § 624.155 / § 626.9541 subsections
☐ CRN identifies facts, individuals, and specific policy language
☐ CRN includes § 624.155(3)(b)(5) perfecting statement
☐ 60-day cure period diaried; do not file suit before expiration
☐ § 627.70152 NOIITL filed for property claims (10-day response)
☐ Mediation / appraisal requirements checked under policy and § 627.7015 (residential mediation)
☐ Hurricane / state-of-emergency claim deadlines reviewed
☐ Contractual suit-limitation diaried (1 year for hurricane; 2 years generally for property losses post-reform; check § 627.70132)
☐ Statutory SOL diaried (5-year first-party bad faith; 4-year third-party excess judgment)
☐ Punitive-damages proffer prepared (Fla. Stat. § 768.72)
☐ Excess-judgment / Berges exposure documented (third-party)
☐ Full claim file requested in writing
☐ DFS complaint filed and confirmation obtained
☐ Bad-faith demand sent via certified mail RRR
☐ Litigation hold issued

Sources and References

• DFS Civil Remedy System: https://apps.fldfs.com/CivilRemedy/
• DFS Consumer Assistance Portal: https://assistcon.myfloridacfo.gov/
• DFS Civil Remedy and Required Legal Notices: https://www.myfloridacfo.com/division/consumers/civilremedy
• Fla. Stat. § 624.155: http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=624.155&URL=0600-0699/0624/Sections/0624.155.html
• Fla. Stat. § 626.9541: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=626.9541&URL=0600-0699/0626/Sections/0626.9541.html
• Fla. Stat. § 627.70152 (Property NOIITL): http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.70152.html
• Fla. Stat. § 627.70131 (Property claim deadlines): http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.70131.html
• Boston Old Colony Ins. Co. v. Gutierrez, 386 So. 2d 783 (Fla. 1980)
• Berges v. Infinity Ins. Co., 896 So. 2d 665 (Fla. 2004)
• Martino v. Wal-Mart Stores, Inc., 908 So. 2d 342 (Fla. 2005)