Civil Remedy Notice of Insurer Violations
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Filing Number:     686293
Filing Accepted:  4/3/2023
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Complainant
Last/Business Name *  
LAUGHLIN   First Name   RICK HILL AND ALLISON
Street Address * 1914 SW 50TH TER
City, State Zip * CAPE CORAL, FL 33914
Email Address * SERVICE@SABLONLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LAUGHLIN   First Name   RICK HILL AND ALLISON
Policy # * AGD30194507 Claim #* CDP-00149610
Attorney
Attorney is Applicable
Last Name* SABLON First Name * MONICA Initial
Street Address* 9160 FORUM CORPORATE PARKWAY, SUITE 350
City, State Zip* FORT MYERS , FL 33905
Email Address * MONICA@SABLONLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
NAIC Company Code 12841
 
Name of individual responsible for violation (if any):* CHRISTOPHER JONES
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Unfair Settlement Practice
* 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.
624.155(1)(b)(3) 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.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* 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 specific policy language relevant to the insurer's misconduct and violations is the Loss Payment provision and the coverage that is afforded under Coverage A-Dwelling of the policy, as well as the coverage afforded under the “Limited Carport(s), Pool Cage(s), and Screen Enclosure(s).”
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The violations alleged are based failure to pay the claim in full and relevant to the insurer’s misconduct is the Loss Payment provision and coverage afforded under Coverage A-Dwelling of the policy. The persons representing the insurer most responsible for and/or knowledgeable of the facts giving rise to the allegations herein are Christopher Jones. The specific policy language relevant to the insurer's misconduct and violations is the Loss Payment provision and the coverage that is afforded under Coverage A-Dwelling of the policy. The facts and circumstances giving rise to the violations are: The insured’s claim results from windstorm and water, with ensuing damages, caused by hurricane Ian on or about September 28, 2022, to the insured property located at 1914 SW 50 Ter, Cape Coral, Florida. The insureds reported the loss to American Integrity Insurance Company of Florida (hereinafter referred to as "the insurer"). While the insurer did send an adjuster to evaluate the damages, there was no genuine adjustment of the claim by the insurer. That is to say, the insurer did not adjust the loss to include obviously related damages or ensuing damages related to Hurricane Ian. Not made whole by the insurer, the insured has been forced to seek legal counsel to protect the insureds’ interests. The insured requested that the insurer provide coverage for the insureds’ damaged pool screen enclosure, but the insureds have been informed no coverage would be extended or afforded. In stark contrast, the declarations page of the relevant insurance policy for which this insured paid a premium clearly reflects additional, which the insureds paid a $43.00 premium, to receive $10,000.00 of coverage for “Limited Carport(s), Pool Cage(s), and Screen Enclosure(s).” The insureds’ informed the insurer of its inaccurate and detrimental determination that there is indeed coverage under this particular insurance policy for damage to screen enclosures at the insured property. The insureds repeatedly informed the insurer of their claim, including in writing on December 21, 2022, to no avail. To date, the insurer failed to acknowledge claims communications and supply information or correct the misapplication of coverage by stating that coverage would be extended for the screen enclosure. The aforementioned conduct is an example of misconduct consistent with unfair claim settlement practices as well as failing to adopt and implement standards for the proper investigation of claims. This conduct is also a specific example of this insurer not attempting in good faith to settle this insureds’ claim 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 and his interests. The failure of the insurer to extend coverage that is obviously listed on the declarations page, coupled with having been given an opportunity to inspect and investigate the claim, and still refusing the extend coverage is bad faith, unfair trade practices, improper investigation and unfair claim settlement practices, which demonstrate the insurer 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 their interests. The insurer failed to adopt proper standards of investigation and adjustment of losses and is otherwise not implementing those standards because full payment and prompt payment for the loss is not occurring and the adjustment has been improper demonstrating unfair trade practices and unfair claim settlement practices. In addition, when the insurer was asked for copies of the policy and claim communications, it failed to comply with the insureds’ request through their counsel. The insureds give this notice in order to perfect the right to pursue the civil remedy authorized by section 624.155, Florida Statutes, in order to cure the conduct giving rise to the violations described herein, the insurer must complete the proper evaluation of the damages and issue payment for all the covered damages.
Comments
User Id Date Added Comment
Monica@SablonLaw.com 09-20-2023 Per the parties' agreement, Civil Remedy Notice of Insurer Violations 686293 is hereby withdrawn.
twilhoit@aiiflorida.com 05-27-2023 May 27, 2023 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, FL 32399-0322 Monica Sablon, Esq. 9160 Forum Corporate Parkway Suite 350 Fort Myers, FL 33905 Re: DFS File No: 686293 Complainant: Rick Hill and Allison Laughlin Insured: Rick Hill and Allison Laughlin Policy No: AGD30194507 Insurer: American Integrity Insurance Company of Florida Claim No: CDP-00149610 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Monica Sablon, Esq.on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on March 30, 2023 and assigned it DFS File No. of 686293. While American Integrity asserts that the subject CRN is legally insufficient and non-compliant with Florida law, American Integrity, without waiving any arguments regarding same, contends that it has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its Insured, Rick Hill and Allison Laughlin. The CRN contains a list of purported violations which are alleged to have been committed by American Integrity. In fact, none of the listed violations/allegations have occurred and/or are irrelevant to the alleged violations and American Integrity categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules contained in the CRN. In addition, American Integrity denies any and all allegations of any kind and/or any inferences therefrom referenced and/or contained in the CRN. American Integrity believes this response adequately addresses the allegations and violations contained within the CRN. Should you have any questions or require any additional information, please do not hesitate to contact the undersigned. Sincerely, Michael S. Sperounes Michael S. Sperounes, Esq. Senior Vice President of Litigation American Integrity Insurance Group cc: Monica Sablon, Esq.via email at: MONICA@SABLONLAW.COM CRN Response If this document contains an excerpt from an American Integrity Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the Insureds on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234
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.

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