Filing Number: 650842
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| Filing Accepted: 10/11/2022 |
| Last/Business Name
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SHOEMAKER
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First Name |
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CHRIS |
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| Street Address
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1066 DEWHURST ST |
| City, State Zip
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PORT CHARLOTTE,
FL
33952
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| Email Address
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LITIGATION@THEFREEMANLAWFIRMPA.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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SHOEMAKER |
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First Name |
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CHRIS |
| Policy # * |
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AGH0375543 |
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Claim #* |
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CHO-00123817 |
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Attorney is Applicable
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| Last Name* |
FREEMAN
First Name *
BRIAN
Initial
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| Street Address* |
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4245 FOWLER STREET |
| City, State Zip* |
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FORT MYERS
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FLORIDA
33901
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| Email Address * |
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LITIGATION@THEFREEMANLAWFIRMPA.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 12841 |
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| Name of individual responsible for violation (if any):*
CHRISTIAN BANKES
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unfair Trade Practice
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Other
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Bad Faith
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
The Insured is in possession of a full and complete certified copy of the Policy and believes his Policy language relevant to the violations includes all applicable policy coverages, loss payment provisions, valuation provisions and other terms and conditions of Policy No. AGH0375543. The following policy provisions from the Insured’s policy of insurance with the Insurer are applicable:
Coverage A - Dwelling
We cover:
a. The dwelling on the “residence premises,” shown in the Declarations, including attached structures and wall-to-wall carpeting if damage to the dwelling is caused by a covered loss.
b. Materials and supplies located on or next to the “residence premises” used to construct, alter or repair the dwelling or other structures on the “residence premises.”
c. In-ground swimming pools including related permanently installed equipment such as pumps and filters.
Coverage B - Other Structures
Coverage C - Personal Property
Coverage D - Loss of Use
Loss Payment
We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be paid upon the earliest of the following:
a. 20 days after:
(1) We receive your written proof of loss and reach a written executed agreement of settlement with you according to the terms of the written agreement; or
b. 60 days after we receive your written proof of loss and:
(1) There is an entry of a final judgement or, in the case of an appeal from such judgement, within 60 days from and after the affirmance of the same by the appellate court; or
(2) Written executed mediation settlement with you according to the terms of the written mediation settlement or an appraisal award.
Loss Settlement.
Covered property losses are settled as follows:
a. Property of the following types:
(1) Personal property;
(2) Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings;
(3) Structures that are not buildings; and
(4) Driveways, walkways or fences;
At “actual cash value” at the time of loss but not more than the amount required to repair or replace with property of similar kind and quality.
b. Buildings under COVERAGE A – Dwelling or COVERAGE B at replacement cost
without deduction for depreciation, subject to the following:
(1) If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, after application of deductible and without deduction for depreciation, but not more than the least of the following amounts:
(a) The limit of liability under this policy that applies to the building;
(b) The replacement cost of that part of the building damaged for like construction and use on the same premises; or
(c) The necessary amount actually spent to repair or replace the damaged building.
(2) If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the building:
(a) The actual cash value of that part of the building damaged; or
(b) That proportion of the cost to repair or replace, after application of deductible and without deduction for depreciation, that part of the building damaged, which the total amount of insurance in this policy on the damaged building bears to 80% of the replacement cost of the building.
(3) To determine the amount of insurance required to equal 80% of the full replacement cost of the building immediately before the loss, do not include the value of:
(a) Excavations, foundations, piers or any supports which are below the undersurface of the lowest basement floor;
(b) Those supports in (a) above which are below the surface of the ground inside the foundation walls, if there is no basement; and
(c) Underground flues, pipes, wiring and drains.
(4) For losses under COVERAGE A- Dwelling, and for losses to buildings covered under COVERAGE B – Other Structures, we will pay the actual cost to repair or replace subject to b.(1) above. However, we will initially pay no more than the “actual cash value” of the insured loss, less any applicable deductible. We will pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred.
If a total loss of the dwelling occurs, we will pay the replacement cost coverage without reservation or hold back of any depreciation in value up to the limit listed on the declaration for COVERAGE A – Dwelling.
However, if the cost to repair or replace the damage is both:
(a) Less than 5% of the amount of insurance in this policy on the building; and
(b) Less than $2,500; we will settle the loss as noted in b.(1) and b.(2) above whether or not actual repair or replacement is complete.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
During the policy period, on December 21, 2021, the Insured’s home located at 1066 Dewhurst St., Port Charlotte, FL, 33952 (“Home”), owned by the named Insured, Chris Shoemaker ("Insured”), suffered wind related physical and structural damage as a direct result of a tornado, an event covered under the subject insurance policy.
The Insured timely reported the loss to his insurance carrier, American Integrity Insurance Company of Florida ("Insurer"). Since the beginning of the claims process, the Insured has fully cooperated in the Insurer's investigation of the Insured’s tornado damage claim.
On March 17, 2021, the Insured reported a claim to the Insurer regarding the damage to the Insured’s home and roof system. The Insurer responded to the notification of the loss and damage claim of the Insured by assigning claim number CHO-00123817 to the Insured’s tornado claim and notifying the Insured that an inspection of his loss and reported damage would be performed. The inspection was conducted by unnamed “roofing consultant” at the request of the Insurer. The unnamed roofing consultant’s inspection was quick and cursory of the damage to the Insured’s roof system and interior damage to the Insured’s home. The Insurer concluded, with no real basis of fact “[t]he inspection found tornado related damage to the screen on the patio and to the fence surrounding the property. No tornado or hail damage was found on the roof of the house. Age related condition issues were found on the roof, which includes shingle granule loss on all slopes, shingle deterioration, and the left slope shows signs of tree rub.” Despite various requests, Insurer has failed to provide a copy of the roofing consultant’s full report.
Due to the obvious ongoing problems at his home, the Insured hired Archer Claims (“Archer”), to determine the extent of damage to his home and roof system as a direct result of the tornado. Archer performed a comprehensive evaluation of the damage to the Insured’s home and roof system and documented numerous missing, broken and cracked tiles and other tornado related damage to the Insured’s home and roof system. The inspection confirmed the Insured’s roof system had severe wind related physical and structural damage and required a full roof system replacement. Archer provided the Insured with an estimate for a full roof system replacement, interior repairs and exterior repairs totaling $43,918.58. Archer’s damage estimate provided detailed, line-item costs for all of the necessary items and applicable taxes for the complete replacement of the Insured’s roof system and the interior and exterior repairs for the Insured’s home. The Insurer is required under the policy to restore the Insured’s home and roof system to its pre-loss condition.
Despite the overwhelming evidence to the Insured’s home and roof system had been significantly physically and structurally damaged by a tornado, all covered losses under the subject insurance policy; the Insurer delayed and unreasonably and improperly investigated and evaluated the amount of damage to the Insured’s home and roof system. The Insurer partially denied the Insured’s claim on the basis of a completely inadequate investigation of the damage to the Insured’s home and roof system indicating the majority of damage to the Insured’s home and roof system was not tornado related and a nonsensical policy interpretation.
On March 31, 2022, the Insurer sent a letter partially denying the Insured’s tornado claim for damage to the Insured’s home and roof system, providing the Insured with a coverage determination letter that concluded; “there would be no coverage afforded for conditions due to wear and tear, marring, deteriorations, inherent vice, latent defect, mechanical breakdown and/or improper installation, etc., as it relates to conditions whether observed or not.” Additionally, the Insured provided the Insurer a Sworn Statement in Proof of Loss (“Proof”). The Proof extensively detailed the damage to the Insured’s home and roof system. Ultimately, the Insurer refused to issue payment for the Insured’s tornado damage claim as this amount was allegedly below the Insured’s tornado deductible.
Moreover, the Insurer did not perform a legally sufficient tornado investigation by failing to perform a substantial structural damage investigation and determination as required by the Florida Building Code. The Insurer’s failure to perform this important substantial structural damage determination further indicates the Insurer did not comply with the basic requirements inherent in the proper investigation of tornado claims, and instead performs inadequate, untimely and incomplete investigations in order to improperly partially deny valid tornado claims. The work of adjusting insurance claims in Florida engages the public trust. In the instant case, the Insurer breached this duty through its improper partial denial and complete failure to properly investigate the tornado claim of the Insured. The Insurer's failure to communicate with the Insured and improper partial denial of the Insured’s tornado claim indicates the Insurer failed to adopt and implement proper standards for the investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so Insured receives good faith, fair and prompt adjustment of claims; and has failed to conduct a full and fair investigation of this tornado damage claim. The Insurer furthermore failed to provide full reasons and facts to the Insured for the partial denial of his tornado claim resulting in the statutory violations as set forth in this notice.
The Insurer also breached its duty to the Insured by failing to timely and promptly pay the correct indemnity owed to its Insured. This duty is owed by the Insurer to its Insured and is inherent in the insurance claims process. The Insured promptly provided all necessary documentation, evidence and information for a timely resolution of his tornado damage claim, including an itemized roof damage estimate and extensive documentation of the damage to the Insurer which clearly shows the Insured’s roof system must be completely replaced and cannot be repaired. However, to date, the Insurer has failed to provide timely and prompt payment for the Insured’s damages.
Interestingly, a number of Insureds in the surrounding area of the Insured’s home have had their insurance claim approved and roof system completely replaced by their insurance carrier. Notwithstanding, the Insurer failed and refused to pay for the complete replacement of the Insured’s roof system. The Insured’s home was exposed to the same excessive winds, yet the Insurer in this case claims the damage to the Insured’s home and roof system is not related to the tornado. The replacement of similar roofs in the area further indicates the Insurer in this case unreasonably and improperly investigated the instant claim, unlawfully undervalued and delayed the Insured’s claim and improperly partially denied his valid tornado damage claim.
To date, the Insured has performed all conditions precedent required of him under the subject policy of insurance with the Insurer and under Florida law. However, the Insurer has failed and refused to properly investigate the Insured’s tornado damage claim, and failed to tender all insurance proceeds due and owing to the Insured under the subject insurance policy. Due to the Insurer's intentional delay and partial denial of the Insured’s tornado claim, the Insured has been forced to obtain legal counsel at a significant cost and expense to attempt to recover what he is legally owed under his insurance policy with the Insurer.
The Insurer violated the statutes set forth above based on the conduct described herein. The Insurer failed and refused to timely tender insurance proceeds required by its insurance policy with its Insured. In addition, the Insurer failed to reasonably and properly settle and resolve the Insured’s tornado damage claim for money damages when under all the facts and circumstances, it could have and should have done so if it had acted fairly and honestly towards its Insured. The Insurer's improper actions are well documented and have occurred with such frequency as to constitute a general business practice and were made in a reckless disregard for its Insured’s rights. The Insurer placed its interest above and before the Insured’s interest in this matter. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must do the following:
A. Create, adopt and implement adequate standards and/or guidelines for the proper
investigation and adjustment of tornado damage claims.
B. Provide sufficient training and supervision of its employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future.
C. Immediately pay the Insured’s tornado damage claim in the amount of Archer’s damage estimate of $43,918.58.
D. Immediately pay to date interest on the Insured’s tornado damage claim to the Insured.
E. Agree to pay the Insured’s reasonable attorney fees and costs pursuant to Fla. Stat. 627.428 which to date totals $15,000.
F. Pay all other and further coverages allowed by law to fully compensate the Insured for his tornado damage claim.
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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.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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