Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 660521

Filing Accepted: 12/8/2022

Print Filing

Complainant

Last/Business Name *

REYNOLDS

First Name

REGINALD

Street Address *

11329 78TH STREET E

City, State Zip *

PARRISH, FL 34219

Email Address *

CICI30045@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		REYNOLDS		First Name		REGINALD
Policy # *		FLP335592		Claim #*		1090909-221013

Attorney

Attorney is Applicable

Last Name*	KRAPF First Name * GRANT Initial W.
Street Address*		2790 SUNSET POINT ROAD
City, State Zip*		CLEARWATER , FLORIDA 33759
Email Address *		GRANT@KRAPFLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		ASI PREFERRED INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 13142

Name of individual responsible for violation (if any):* CASEY DAVIS, JOHN ESKRIDGE, JAMES HENDERSON, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, ASI PREFERRED INSURANCE CORPORATION WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Unfair Trade Practice
	Claim Denial
	Other : Not treating the policyholder with good faith claims conduct
	Other : Looking for ways to deny full recovery to the Claimant
	Other : Looking for ways to delay full recovery to the Claimant
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
	Other : Failing to provide the Claimant with the full benefits awarded to him under the contract of insuranc
	Other : Not adjusting claims and evaluating loss properly
	Other : misrepresenting the terms of the policy and the benefits available under policy

* Statutory provision(s) which the insurer allegedly violated.

	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.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	626.9541(1)(i)(3)(d)		Denying claims without conducting reasonable investigations based upon available information.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

ASI Preferred Insurance Corporation (the “Insurer”) has committed the following in handling the Claimant’s claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 3) looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; and 9) failing to affirm or deny full or partial coverage of claims within 30 days of the sworn proof of loss. The Claimant timely submitted a claim to the Insurer on August 26, 2022, for wind damage sustained to the above-referenced insured property on July 21, 2022, including the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 1090909-221012 to the loss. The Insurer then inspected the property and determined that the reported damages were not covered under the policy. Specifically, the Insurer’s coverage letters stated that it “found granule loss and high nailing to the roof. There was no sudden and accidental wind damage observed for your roof. Granule loss is a result of long term wear and tear and high nailing is a result of improper installation. These perils are excluded from coverage in the homeowners policy.” Notably, the Insurer never retained a professional engineer to determine the cause of loss. Given the scope and nature of the damage, the Claimant retained a public adjuster who produced an estimate, dated October 19, 2022, estimating $46,384.45 in covered damages; whereas the Insurer’s adjuster attributed the damages to “long term wear and tear and improper installation” The Insurer and its hired guns arrived at these conclusions because they failed to conduct a thorough and adequate investigation or intentionally ignored the damage observed thereby failing to make truthful and unbiased report of the facts after conducting the investigation. As a result, the Insurer misrepresented the loss and issued a wrongful denial. The damage was, however, caused by a windstorm. Despite the obvious covered wind damage under this policy, the Insurer here placed its financial interest over the health and safety of the Claimant by denying the claim. The foregoing is an underhanded attempt to place the financial interests of the Insurer over those of the Claimant and to delay and frustrate the Claimant’s ability to have the claim adjusted promptly to begin restoring his property to begin restoring the property to its pre-loss condition. The Insurer has failed to affirm or deny full or partial coverage of claims within 30 days of the Claimant providing a sworn proof of loss statement. Specifically, on October 22, 2022, Claimant’s legal counsel sent the Insurer a sworn statement in proof of loss. To date, Claimant has not received a response from the Insurer as required by Florida Statute 626.9541(1)(i)(3)(e). The Insurer’s actions and inactions continue to frustrate and delay the resolution of Claimant’s claim. Although the Insurer and Claimant are in dispute about how the roof was damaged, the Insurer knows or should know that when independent perils coverage and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist when an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. At 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. At 697. Lastly, the Insurer’s field adjuster knew or should have known that over 25 percent of the Claimant’s roof was damaged as a result of a covered peril, and presumably did. The Insurer also knows that the Claimant needs a new roof in order to comply with the Florida Building Code, because more than 25 percent of the Insurer’s roof is damaged and matching roofing cannot be purchased. The Insurer did not allocate enough coverage to pay for a full re-roof despite knowing it is obligated to do so. According to Florida Statute s. 627.7011(1)(b), Insurers have a duty to cover all costs necessary to meet applicable laws and ordinances regulating the repair of any property and Florida Statute s. 626.9744 requires that the Insurer make reasonable repairs or replacement that match the quality, color or size of the items that needs repair. This has further delayed the Claimant from being able to restore the property to its pre-loss condition and is an underhanded attempt to place the financial interest of the Insurer over Claimant. In short, Insurer is not acting with due regard for the Claimant’s interests or safety. In Florida the work of adjusting insurance claims engages the public trust. Insurers have a duty to treat all claimants equally and the Insurer has breached this duty. The Insurer has conducted a poor and inadequate investigation and has denied coverage for the loss that occurred at the Claimant’s property to further frustrate and delay the Claimant’s claim. The Insurer is placing its financial interests over those of the Claimant and the Claimant’s safety. The foregoing has only delayed the Claimant’s ability to begin restoring the property to its pre-loss condition. The Insurer’s actions amount to but are not limited to the following: 1. Claim denial. 2. Not treating the policyholder with good faith claims conduct 3. Looking for ways to reduce recovery to the Claimant 4. Looking for ways to deny recovery to the Claimant 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant 6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests 7. Placing the financial interest of the Insurer over that of the Claimant 8. Conducting inadequate investigations 9. Failing to affirm or deny full or partial coverage of claims within 30 days of the sworn proof of loss. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) Admit full coverage for the Claimant’s loss. (2) Tender full benefits owed to the Claimant under the insurance contract. (3) Pay all attorney’s fees, costs, and interest. (4) Implement policies and procedures to ensure that all Claimants are treated with equal fairness to the investigation of claims. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: ASI Preferred Insurance Corporation P.O. Box 20089 St. Petersburg, FL 33742 claims@asicorp.org

Comments

User Id		Date Added		Comment
grant@krapflegal.com		05-11-2023		The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice.
greyes@asicorp.org		01-30-2023		While ASI Preferred Insurance Corp's response believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the notice in writing to Krapf Legal, on December 12,2022.

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. 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.

DFS-10-363
Rev. 10/14/2008