Civil Remedy Notice of Insurer Violations
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Filing Number:     701993
Filing Accepted:  6/26/2023
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Complainant
Last/Business Name *  
HIS AND HERS ROOFING LLC   First Name  
Street Address * 515 18TH STREET
City, State Zip * ORLANDO, FL 32805
Email Address * JBAER@HHROOFS.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   SPENCER   First Name   BARRY
Policy # * ATH1047061 Claim #* AH138749
Attorney
Attorney is Applicable
Last Name* TORRES First Name * ALEXIS Initial
Street Address* 200 SE 9TH STREET
City, State Zip* FORT LAUDERDALE , FL 33316
Email Address * ALEXIS@ROBERTMALOVELAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN TRADITIONS INSURANCE COMPANY
NAIC Company Code 12359
 
Name of individual responsible for violation (if any):* JUSTIN BARLEY AND NICOLE GREEN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Delay
* 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)(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.

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

June 23, 2023 Sent Via E-mail and DFS website: aticclaims@westpointuw.com American Traditions Insurance Company ATTN.: Justin Barley and Nicole Green PO BOX 2800 Pinellas, FL 33780 RE: Complainant : HIS & HERS ROOFING, LLC (A/A/O) Insured : BARRY & BRENDA SPENCER Policy # : ATH1047061 Claim # : AH138749 Property Address : 2718 Auld Scot Blvd Ocoee FL 34761 Dear Justin Barley and Nicole Green: As discussed in greater detail in the notice, Carrier has not attempted in to settle the 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 their interests. Carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured or complainant. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). Carrier’s actions are in violation of Florida Statute §§624.155(1)(b)(1); 626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(i). Insureds home was damaged by Hurricane Ian on or about September 29, 2022. Carrier received insured’s claim upon receipt of a valid assignment of benefits in complainant’s favor. A claim was opened and a number assigned to the loss. Carrier then retained an adjuster to perform an inspection and prepare an estimate. Mr. Barley inspected the home on May 2, 2023. During this inspection, as outlined in an estimate, he discovered damage to the fence and roofing system near the solar panels. He then finalized an estimate on the June 13, 2023 with a total amount at RCV of $4,358.56. Carrier then sent a letter on June 13, 2023, stating that the damage was a direct loss due to the hurricane, and was covered under the policy. Carrier then cited and referenced to the relied upon estimate prepared by as the basis for non-payment. Specifically, the estimate was less than the deductible. Carrier did not explain why the roof did not warrant a replacement or even a repair. Instead, the letter only stated that the fencing back needed to be replaced, but did not explain why. In reviewing the estimate carrier relies upon, there are missing line items that would have increased the estimate. If one were to believe that a hurricane damaged electrical solar panels directly attached to the roof while avoiding the remainder could occur in real life, the estimate fails to acknowledge the very minimal but necessary waste needed to make the repair carrier outlined. While the solar panels may be excluded in the policy, the repairs outlined to restore them would cause damage to the shingles below. Those shingle repairs would be covered, and carrier knew this. Carrier also did not explain how only a small portion of the fence was damaged and the remainder went untouched by a category 5 hurricane. All of this shows that carrier has no intention of accurately investigating and adjusting a loss but merely doing a half job to appear compliant. This is likely because they hope the insured will assume the information to be correct and go away, or because carrier knows it will later delay the claim by forcing parties to appraisal, costing the insured at least another 1-2k for the appraiser and umpire. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless regard for claimant’s rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) pay the total covered loss in the amount of $39,497.70. A copy of this letter and filed form submitted to the FDFS has been emailed as indicated above. Should you have any questions upon receipt of this filing, please do not hesitate to contact me at (954) 861-0384. We appreciate your attention to this matter. Sincerely, Alexis Torres Alexis Torres, Esq. Attorney at Law Enclosed: Civil Remedy Notice Filing
Comments
User Id Date Added Comment
Tom@zinoberdiana.com 07-28-2023 July 27, 2023 Via Electronic Posting to the DFS Website Department of Financial Services Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399-6322 Re: Insureds: Barry Spencer and Brenda Knapp Spencer Insurer: American Traditions Insurance Company Filing No.: 701993 Claim No.: AH138749 Policy No.: ATH1047061 Date of Loss: 9/29/22 (reported 5/1/23) Property: 1573 Wild Fox Drive, Casselberry, Florida 32707 Dear Sir or Madam: This correspondence shall serve as a formal response on behalf of American Traditions Insurance Company (hereinafter “American Traditions”) to the Civil Remedy Notice of Insurer Violation (hereinafter “Notice”) filed by His and Hers Roofing, LLC, on behalf of Barry and Brenda Spencer (hereinafter “Assignee”) that was accepted by the Department of Financial Services (hereinafter “Department”) on June 26, 2023. The Department’s Filing Number is 701993. I. The Notice fails to satisfy the requirements of Florida law and should be rejected. As to the content of the Notice, it is important to note that the Notice fails to comply with the specific requirements mandated by Florida Statutes §624.155. As such, the Notice should be rendered null and void, and should be rejected by the Department. Specifically, the Notice fails to comply with Florida Statute 624.155(3)(b)(2), Florida Statutes, which requires that the Notice state, with specificity, the facts and circumstances giving rise to the alleged violation. Rather than complying with this requirement, the Notice includes jumbled assertions of unqualified opinion, legal conclusions, conjecture, and inaccurate statements of fact cast in the light most favorable to the attorney who drafted the Notice. Additionally, the Notice should be rejected because it does not state true specific amounts or damages that are amenable to “cure” by payment and are not available under the policy of insurance or under the Civil Remedy Statute. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000), the Florida Supreme Court held that in the context of a first-party insurance claim, the notice must state “the contractual amount due to the insured.” See also Longpoint Condo. Assn. v. Allstate Ins. Co., 2005 WL 1315810 (N.D. Fla.)(holding a civil remedy notice insufficient which did not state the amount of the appraisal award nor an assertion that such an amount would be accepted by the insured if tendered by the insurer). Thus, the Notice, in contradiction to the statutory purpose, fails to give the insurance company the chance to avoid litigation and resolve disputes. Lane v. Westfield Insurance Company, 862 So.2d 774, 779 (Fla. 5th DCA 2003). Finally, it is of primary importance to American Traditions that it is provided an opportunity to respond to the concerns of its policyholders which it routinely does as a matter of course. Instead, the Notice in this matter provides nothing more than general statements regarding a statute applicable to the investigations of insurance claims and unsupported allegations of fact that purportedly support the incorrect notion that American Traditions denied the Insureds’ claim in bad-faith. The deficiencies in this Notice precludes American Traditions from providing an adequate response as provided for in Section 624.155, Florida Statutes. Therefore, American Traditions requests that the Department reject the Notice as a result of the deficiencies noted hereinabove. II. Despite the deficiencies, American Traditions denies all allegations contained in the Notice. Notwithstanding the deficiencies in the Notice, American Traditions denies it committed the acts and violated the statutes cited in the Notice. American Traditions hereby denies each and every allegation contained in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of this matter. American Traditions has acted fairly and with due diligence throughout the entire investigation and handling of this claim. To the extent that this reply does not fully address and respond to the allegations set forth by the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations therein. American Traditions denies each and every allegation contained in the Complainant’s Civil Remedy Notice and responds to them individually as follows: The Notice lists two (2) reasons for submitting the Notice which are: 1.Unfair Trade Practice; and 2. Claim Delay. As indicated in detail below, the Notice fails to establish or set forth any specific facts that would support the allegations asserted in support of the perceived violations. Specifically, American Traditions responds as follows: Unfair Trade Practice: • This allegation is wholly without basis in law or fact and is therefore denied. The Complainant should also immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. At all times material to this claim, American Traditions acted in good faith towards its insureds, as it does on every claim. Claim Delay: • This allegation is wholly without basis and therefore denied. The Complainant should immediately withdraw this allegation from its Notice as well. At all times material to this claim, American Traditions acted timely, diligently and responsibly in its pursuit of coverage. Any perceived delays alleged in the Notice are not due to the actions of American Traditions nor did American Traditions have control over any such actions causing any perceived delay. Nonetheless, American Traditions received notice of the claim on or about May 1, 2023 and provided the insureds with its coverage determination on June 13, 2023. Alleged Statutory Violations In his Notice, the Claimant lists three (3) statutes that have allegedly been violated by American Traditions. In response, American Traditions denies each of the allegations of statutory violation as all are wholly without merit, and specifically asserts the following: • §624.155(1)(b)(1): Denied. At all times material to this claim, American Traditions acted fairly and honestly towards the Insureds and with due regard for their interests. American Traditions has engaged in a thorough investigation of the subject claim and incurred a significant expense in doing so. At the completion of its investigation, American Traditions advised the Insureds that the damages to the fence fell below the applicable deductible and the remaining claimed damages were not covered by the policy. All actions taken by American Traditions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. • §626.9541(1)(i)(3)(a): Denied. The Complainant should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. American Traditions has always implemented standards for investigating and adjusting claims commensurate with the requirements of Florida Statutes, and it will continue to do so. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Absolutely no facts or circumstances supporting this allegation have been provided by the Insureds in the Civil Remedy Notice. • §626.9541(1)(i)(3)(i): Denied. The Complainant should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. American Traditions has always implemented standards for investigating and adjusting claims commensurate with the requirements of Florida Statutes, and it will continue to do so. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Absolutely no facts or circumstances supporting this allegation have been provided by the Insureds in the Civil Remedy Notice. Alleged Violations of Policy of Insurance The Notice requires the Complainant to reference the specific policy language that is relevant to the violation. Rather than complying with this requirement, the Notice simply lists “Perils Insured Against” and “Loss Settlement Provision.” The Notice also fails to provide any factual basis to support the purported violation of the policy. Nonetheless, American Traditions states with confidence that it acted promptly, fairly, and in good faith towards the Insured and/or their representative(s) at all times material to the adjustment and investigation of this claim. American Traditions denies violating any provision or duty set forth in the policy. Alleged Factual and Circumstantial Support for the Complainant’s Notice The Notice requires the Complainant to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” In part, the Notice incorporates vague and unsubstantiated allegations which purportedly give rise to the violation. Therefore, these portions of the Notice should be dismissed for failure to properly complete the form pursuant to Florida Statute §624.155, as the alleged violations are without basis in law or fact. The allegations set forth are so vague and non-specific that they fail to allow a reasonable response. Nevertheless, American Traditions asserts that all actions taken have been made entirely in good faith and for the purposes of fair, just and timely disposition of this matter. Additionally, and to the extent possible, American Traditions specifically responds to each of the following allegations set forth in this section of the Notice below. The facts of this matter are clear, and these are they: American Traditions provided homeowners insurance coverage to the Insureds, Barry Spencer and Brenda Knapp Spencer, for property located at 2718 Auld Scott Blvd, Ocoee, Florida 34761 (the “Insured Property”) under the terms of policy number ATH1047061 (the “Policy”). On May 1, 2023, and approximately seven (7) months after the date of loss, the Insureds reported a claim to American Traditions for damage to the Insured Property which purportedly occurred on or about September 29, 2022. American Traditions opened a claim and inspected same. Upon completion of its inspection, American Traditions advised the Insureds of its coverage determination. Specifically, American Traditions, after two separate inspections of the Insured Property, found that reported damages to the fence had been replaced/repaired. In addition, American Traditions found damage to the roof around the solar panels which was caused by installation of the solar panels two years prior. The Notice absolutely misstates and mischaracterizes the coverage determination made by American Traditions. On June 13, 2023, American Traditions sent correspondence to the Insureds advising them that the damage to the fence was covered, however, the amount fell below the applicable hurricane deductible. In addition, American Traditions advised the Insureds that the damage around the solar panels on the roof was not caused by Hurricane Ian, but by installation deficiencies. The Notice is riddled with errors, including where it states that American Traditions stated “that the damage was a direct loss due to the hurricane, and was covered under the policy.” Again, this is factually inaccurate. In its June 13, 2023 letter, American Traditions advised the Insureds that the damages to the fence were covered, but fell below the applicable deductible. The letter further stated that the damages to the roof were not covered. Another blatant error is where the Notice states “Carrier did not explain why the roof did not warrant a replacement or even a repair.” In fact, the coverage letter, dated June 13, 2023, stated “Our investigation revealed no storm created (wind, hail, or tree impact) openings to the composition roofing system.” Further, it stated “Unfortunately, the policy does not provide coverage for damage related to exterior failures due to wear, tear, age related deterioration, and deferred maintenance of the roofing system.” Lastly, it stated “With the absence of a storm created opening, regrettably the policy cannot afford coverage to the interior damage to the garage ceiling.” Lastly, the Notice argues that “Carrier also did not explain how only a small portion of the fence was damaged and the remainder went untouched by a category 5 hurricane.” Here it is clear that the Complainant either does not know all of the facts or is simply willing to ignore the facts. If Complainant had spoken with the Insureds, whom they claim to represent, it would know that the Insureds had the damaged portion of the fence replaced before American Traditions ever inspected the Insured Property. In support thereof, the Insureds provided the invoice from Fence Outlet which was dated October 31, 2022. It should also be pointed out that while Complainant seems so concerned about the fence in the Notice, the estimate it provided to American Traditions excluded same. Based on the blatant omissions from the Notice, the Department should immediately reject the Notice filed by Complainant. Based on the facts presented in detail above, it is clear that there is no merit to the allegations in the Notice. American Traditions asserts that all actions taken have been made entirely in good faith and for the purposes of fair, just and timely disposition of this matter. Additionally, American Traditions has specifically responded to the unsubstantiated allegations set forth in the Notice with the true facts of this matter as have been set forth hereinabove. Based on the facts presented in detail above, American Traditions wholly denies the Complainant’s allegations contained within the Notice, and in support thereof asserts that it acted in accordance with Florida law, its policy of insurance, and in good faith towards the Insureds and/or his representative(s), as well as other American Traditions policyholders. III. Demands to Cure Defects The Notice states that to cure the alleged defects, American Traditions must “pay the total covered loss in the amount of $39,497.70.” American Traditions is unclear as to where this cure amount came from inasmuch as it is nearly $30,000.00 less than the estimate that has been provided to American Traditions by His and Hers Roofing in support of its claim. No documentation has been produced by His and Hers Roofing and/or the Insureds to suggest that the amount being demanded is due and owing or that any repairs, other than those to the fence facilitated by the Insureds, have been performed. American Traditions again asserts that all actions have been performed in good faith and for the purpose of moving the Claim towards a just and equitable resolution. IV. Conclusion In closing, American Traditions first believes that the Civil Remedy Notice does not comply with section 624.155, Florida Statutes, and should therefore be rejected and returned by the Department of Financial Services due to its failure to comply with § 624.155, Fla. Stat., and Florida case law. Regardless of the lack of compliance, American Traditions denies all allegations contained in the Civil Remedy Notice and submits there are no violations. American Traditions denies all of the allegations contained in the Civil Remedy Notice and note that the Notice is riddled with inaccuracies. Due to the lack of any reliable or authoritative basis in fact or circumstances to support such allegations, we request, through this response, that the Department of Financial Services return the Notice for lack of specificity in accordance with Florida Statutes. While this response is meant to be comprehensive, American Traditions’ response above is based upon the limited information provided in the Civil Remedy Notice and the information we have to date. If His and Hers Roofing feels that we are not in possession of all the facts, please inform us immediately. Please note that American Traditions’ response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for the lack of compliance with F.S. § 624.155. Also, this letter, or any act or failure to act on the part of American Traditions or any agent or representative of American Traditions should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service by Mr. and Mrs. Spencer and/or their representative(s), available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Best Regards, William R. Burke William R. Burke, Esquire Zinober Diana & Monteverde, P.A. Bill@ZinoberDiana.com
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