Filing Number: 654933
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| Filing Accepted: 11/1/2022 |
| Last/Business Name
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ERIK AND VIKKI
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First Name |
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IVERSON |
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| Street Address
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3309 SW 3RD LANE |
| City, State Zip
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CAPE CORAL,
FL
33991
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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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ERIK AND VIKKI |
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First Name |
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IVERSON |
| Policy # * |
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AGH0383928 |
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Claim #* |
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CHO-00124133 |
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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):*
STEPHANIE RODRIGUEZ
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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 Insureds are in possession of a copy of the Policy and believe their Policy language relevant to the violations includes all applicable policy coverages, loss payment provisions, valuation provisions and other terms and conditions of Policy No. AGH0383928. In particular, the Insureds refer to the following policy coverages and included policy language:
COVERAGE A – Dwelling
We cover:
1. the dwelling on the Described Location shown in
the Declarations, used principally for dwelling purposes,
including structures attached to the dwelling;
2. materials and supplies located on or next to the
Described Location used to construct, alter or repair
the dwelling or other structures on the Described
Location; and
3. if not otherwise covered in this policy, building
equipment and outdoor equipment used for the
service of and located on the Described Location.
13.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 payable 60 days after we receive
your proof of loss and:
a. reach an agreement with you;
b. there is an entry of a final judgment; or
c. there is a filing of an appraisal award with us.
Loss Settlement. Covered property losses are
settled as follows:
a. (1) Personal property;
(2) Awnings, carpeting, household appliances,
outdoor antennas and outdoor equipment,
whether or not attached to buildings; and
(3) Structures that are not buildings;
at actual cash value at the time of loss but not
more than the amount required to repair or replace.
b. Buildings under Coverage A or 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) We will pay no more than the actual cash
value of the damage unless:
(a) actual repair or replacement is complete;
or
(b) the cost to repair or replace the damage
is both:
(i) less than 5% of the amount of insurance
in this policy on the building;
and
(ii)
DP 00 03 07 88 Copyright, Insurance Services Office, Inc., 1988, 1992 Page 7 of 9
less than $2500.
(5) You may disregard the replacement cost
loss settlement provisions and make claim
under this policy for loss or damage to
buildings on an actual cash value basis.
You may then make claim within 180 days
after loss for any additional liability on a replacement
cost basis.
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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 Insureds’ home located at 3309 SW 3rd Lane, Cape Coral, Florida 33983 owned by Erik and Vikki Iverson ("Insureds"), suffered tornado related physical and structural damage as a direct result of a tornado, a covered loss under the subject insurance policy. Please see policy language above that indicates coverage for tornado damage to the Insureds’ home and roof system.
Subsequent to the tornado, the Insureds promptly reported the loss to their insurance carrier, American Integrity Insurance Company ("Insurer"). Since the beginning of the claims process, the Insureds have fully cooperated in the Insurer's investigation of the Insureds’ tornado damage claim.
Despite overwhelming evidence the Insureds’ roof system of the Insureds’ home had been significantly damaged by the tornado, all covered losses under the subject insurance policy; the Insurer has unreasonably and improperly investigated and evaluated the amount of damage to the Insureds’ home and roof system. The Insurer has performed a completely inadequate investigation of the damage to the Insureds’ home and roof system.
The Insurer allegedly retained an unidentified person to investigate the damage to the Insureds’ roof system. In a letter dated April 6, 2022, the Insurer claims “there would be no coverage extended due to wear and tear, marring, deterioration, inherent vice, latent defect, defect, mechanical breakdown and/or improper installation, etc., as it relates to conditions on your roof whether observed or not.”
Furthermore, the fact that the Insurer included every other possible source of damage imaginable, and even an “etc.,” aside from the discernable and clearly evident tornado damage which occurred on the date of loss, is further evidence of the baseless and unfounded claim investigation performed by the Insurer.
Archer Claims investigated the damage to the Insureds’ home and roof system and prepared a damage estimate in the amount of $47,708.26, which was the necessary cost to return the Insureds’ home and roof system to their pre-loss condition. Additionally, the Insureds submitted a Sworn Proof of Loss in the amount of $45,208.26 representing the Archer damage estimate net the applicable deductible.
Despite receipt of Archer’s detailed damage estimate, the Insurer has not extended coverage for the damages set forth in Archer Claims’ damage estimate and the Sworn Proof of Loss. The Insurer failed to extend full coverage for the Insureds’ clearly evident tornado damage, indicating the Insurer does not have proper standards for investigating the proper scope and amount of damage caused by a covered loss. The Insureds provided all the evidence necessary supporting the actual costs associated with the complete replacement of their roof system. However, despite this evidence and information, the Insurer failed and refused to pay for the Insureds’ damage in order to restore their home and roof system to its pre-loss condition.
Moreover, the Insurer did not perform a legally sufficient tornado damage investigation by failing to perform a substantial structural damage investigation and determination as required by The Florida Building Code. The Insurers failure to perform this very important substantial structural damage determination further indicates the Insurer did not comply with the basic requirements inherent in the proper investigation of tornado damage claims, and instead performs inadequate investigations in order to improperly completely deny claims. The Insureds provided the Insurer with an overwhelming amount of photographic evidence to support the extensive damage to their roof system, requiring their roof system to be completely replaced and the overwhelming evidence pertaining to the extent of the interior damage to the Insureds’ home that must be repaired to restore the Insureds’ home to its pre-loss condition.
The work of adjusting insurance claims in Florida engages the public trust. In the instant case, the Insurer breached this duty through its complete failure to properly investigate the tornado damage claim of the Insureds. The Insurer's failure to properly inspect and investigate the damages to the Insureds home, failure to communicate with the Insureds, and improper handling of the Insureds’ tornado damage claim clearly indicates the Insurer failed to adopt and implement proper standards for the investigation, evaluation and adjustment of claims; failed to properly train, manage, supervise and promote claims adjusters so insureds receive good faith, fair and prompt adjustment of claims; and 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 Insureds for the complete denial of their tornado damage claim resulting in the statutory violations as set forth in this notice.
The Insurer also breached its duty to the Insureds by failing to timely and promptly pay the correct indemnity owed to its Insureds. This duty is owed by the Insurer to its Insureds and is inherent in the insurance claims process. The Insureds promptly provided all necessary documentation, evidence and information for a timely resolution of their tornado damage claim, including an itemized roof damage and interior damage estimate and extensive documentation of the damage to the Insurer which clearly shows the Insureds’ roof system must be completely replaced and cannot be repaired. However, to date, the Insurer failed to provide timely and prompt payment for the Insureds’ damage.
To date, the Insureds performed all conditions precedent required of them undertheir insurance policy with the Insurer and under Florida law. However, the Insurer and its agents failed and refused to properly investigate the Insureds’ tornado damage claim and failed to tender all insurance proceeds due and owing to the Insureds under the subject insurance policy. Due to the Insurer's intentional delay of the Insureds’ tornado damage claim, the Insureds were forced to obtain legal counsel at a significant cost and expense to attempt to recover what they are legally owed under their insurance policy with the Insurer.
The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or
security against a contingent loss. Fla. Stat. § 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 insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Simply put, American Integrity Insurance Company failed to comply with its duty to indemnify the Insureds and breached the insurance policy.
American Integrity Insurance Company failed and refused to timely adjust, repair and pay the Insureds’ tornado damage claim. The Insurer failed and refused to pay any insurance proceeds to date owed to the Insureds as required by the insurance policy and Florida law. Refusal and failure to pay the Insureds’ claim, when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insureds is a breach of the insurance policy and a violation of Florida Law.
The actions taken by the Insurer in the handling and adjustment of the Insureds’ tornado damage claim were willful, wanton, and in disregard for the rights of its Insureds and occur with such a frequency as to indicate a general business practice in violation of Florida Statutes § 624.155 and § 626.9541.
Based on the foregoing actions and omissions, American Integrity Insurance Company engaged in wrongful claims handling conduct, including but not limited to, the following:
1) Improper complete claim denial;
2) Improper claim delays;
3) Failure to respond to communications from their insureds within fourteen days;
4) Not conducting a full and fair investigation of the Insureds’ claim;
5) Looking for ways to deny recovery to the Insureds;
6) Overlooking covered damages to the Insureds’ home and roof system and failing to hire an engineer when causation was in question;
8) Failing to pay the necessary amounts due and owing to restore the Insureds’ home and roof system to its pre-loss condition;
9) Not adjusting the claim and not evaluating the loss properly, promptly, and fairly so as to provide full and prompt indemnity to its Insureds;
10) Failing to implement proper standards for the adjustment and investigation of insurance claims;
11) Failing to pay the requisite monies owed for the Insureds’ loss, despite receipt of a proof of loss and supporting documentation;
12) Failing to share its damage estimates or engineering reports (if any) with the Insureds and/or their Public Adjuster;
13) Not training, supervising or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed;
14) Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses.
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 Insureds. In addition, the Insurer failed to reasonably and properly settle and resolve the Insureds’ 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 Insureds. The Insurers’ 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 Insureds’ rights. The Insurer has placed its interest above and before the Insureds’ 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 Insureds' tornado damage claim in the amount of the Archer Claims' damage estimate of $47,708.26, less the $2,500.00 applicable tornado deductible.
D. Immediately pay interest on the Insureds’ tornado damage claim to the Insureds.
E. Agree to pay the Insureds’ reasonable attorney fees pursuant to Fla. Stat. 627.428 and all costs allowed by law, which to date total $15,000.00.
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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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