Civil Remedy Notice of Insurer Violations
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Filing Number:     782551
Filing Accepted:  9/12/2024
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Complainant
Last/Business Name *  
THE FOUNTAINS II CONDOMINIUM ASSOCIATION, INC   First Name  
Street Address * 7466 NW 8TH STREET
City, State Zip * MIAMI, FL 33126
Email Address * SDFLORIDALAW@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   THE FOUNTAINS II CONDOMINIUM ASSOCIATION, INC   First Name  
Policy # * AMC3365900 Claim #* CLM23603
Attorney
Attorney is Applicable
Last Name* SPIVAK First Name * AVRAHAM Initial A
Street Address* 16853 NE 2ND AVE., SUITE 302
City, State Zip* NORTH MIAMI BEACH , FL 33162
Email Address * ABE@SDFLORIDALAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN COASTAL INSURANCE COMPANY
NAIC Company Code 12968
 
Name of individual responsible for violation (if any):* COMPANY
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss Payment a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged property; (2) Pay the cost of repairing or replacing the lost or damaged property, subject to b. below; (3) Take all or any part of the property at an agreed or appraised value; or (4) Repair, rebuild or replace the property with other property of like kind and quality, subject to b. below. We will determine the value of lost or damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of the Valuation Condition in this Coverage Form or any applicable provision which amends or supersedes the Valuation Condition.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This claim has been delayed for many years and not dealt with properly. Extreme delays for hurricane damage caused by Hurricane Irma. As well as, delaying the litigation.
Comments
User Id Date Added Comment
mstrauss@kelleykronenberg.com 11-07-2024 Sent Via Certified Mail and Email Avraham A Spivak 16853 NE 2n Ave., Suit 302 North Miami Beach, FL 33162 abe@sdfloridalaw.com RE: RESPONSE TO CIVIL REMEDY NOTICE NUMBER 782551 Insured: The Fountains II Condominium Association, Inc Policy Number: AMC3365900 Claim Number: 4146418 Date of Loss: 9/10/2017 Nature of Loss: Hurricane Irma CRN Number: 782551 CRN Acceptance Date: 9/12/2024 Dear Mr. Spivak: Please accept this letter as American Coastal Insurance Company’s (“AmCoastal”) response to the Civil Remedy Notice of Insurer Violations, Filing Number 782551 (“CRN”) filed by your office on behalf of The Fountains II Condominium Association, Inc. (“Complainant” or “Insured”) relating claim for property damage occurring on or about September 10, 2017, bearing claim number 4146418 (the “Loss” or “Claim”) made under Policy Number FSF16007791, which insured the properties located at 15605 – 15645 SW 74 Cir Dr, Miami, FL 33193 (the “Property”). As an initial matter, AmCoastal denies that any of its actions taken with regard to the Insured’s Claim resulted in a violation of Florida’s bad faith laws as alleged in the CRN. Rather, at all times, AmCoastal has acted in good faith in its investigation and handling of the Claim and with regards to the best interest of our Insured. AmCoastal rejects the Insured’s allegations that it acted in bad faith with respect to any aspect of its handling or investigation of the Claim. AmCoastal specifically denies each and every allegation contained in the CRN. AmCoastal requests the CRN be rejected as it fails to comply with several of the requirements of the Civil Remedy Notice of Insurer Violation document provisions as set forth in Florida Statutes § 624.155 and Florida case law. While AmCoastal specifically denies each and every allegation set forth therein, AmCoastal states that the Notice must be rejected and returned by the Department of Financial Services as it fails to comply with the specific information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions in Florida Statute § 624.155 and Florida Case law. Procedurally, the CRN is deficient because it incorrectly identifies the claim number KY22L2940993. AmCoastal assigned claim number KY22K2940993 to the Loss, and not the claim number referenced in the CRN. Further, the CRN omits required information and does not identify any policy language at all. Therefore, the CRN must be rejected due to its procedural and substantive deficiencies. Substantively, the CRN is deficient because it fails to “describe the facts and circumstances giving rise to the insurer’s violation,” to enable the insurer to investigate and resolve the claim, as required by Florida Statute § 624.155(3)(b)(2). Contrary to the intent of the statute, the Notice filed by Complainant contains overbroad, inaccurate, and misleading allegations that do nothing to enable AmCoastal to cure the alleged violations. For example, the Notice inaccurately alleges that AmCoastal’s actions delayed the indemnification; however, to the contrary, it was the Claimant’s actions that delayed the claim as the Insured refused to name an impartial appraisal as required by the Policy and Florida law. Further, after naming an impartial appraiser the Insured’s appraiser continue to cause delays by refusing to agree to an umpire. Any alleged delay in the completion and conclusion of this claim is due to the Insured’s failure to comply with the Policy and act in good faith to resolve the dispute as to the quantum of the claim. Therefore, the CRN must be rejected due to its procedural and substantive deficiencies. I. THE CRN ALLEGATIONS The CRN asserts the following reasons for the notice: • Claim Delay In the CRN, the Claimant alleges that AmCoastal violated the following statute and applicable language (as taken from the CRN): • 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. The purpose of Fla. Stat. Section 624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. See Talat Enterprises, Inc.; see also Lane v. Westfield Ins. Co., 862 So.2d 744 (Fla. 5th DCA 2003); Julien, 311 So. 3d 875 (Fla. 4th DCA 2021); Heritage Corp., 580 F. Supp. 2d 1294, 1298 (S.D. Fla. 2008). Without setting forth facts or circumstances of the alleged violation of policy language, American Coastal cannot address the alleged violations or properly respond. See id. Here the Claimant failed to strictly comply with the Florida Statute § 624.155 CRN. In direct contravention to the explicit, strictly construed requirements of Florida Statute § 624.155(3)(a), Plaintiff's CRN failed to: 1) correctly identify the claim number related to the Insured for loss alleged in the CRN; 2) correctly identify the Insured’s property address; 3) reference to any policy language relevant to the alleged violation; & 4) provide any factual narrative describing the facts and circumstances giving rise to the alleged violation. The CRN fails to comply with the Florida Statute § 624.155. This is in direct contravention to the explicit, strictly construed requirements of Florida Statute § 624.155(3)(b), Insured’s CRN failed to provide any facts or circumstances that give rise to the alleged violations; refer to the specific policy language relevant to the violation; or provide a statement that the CRN is to provide the notice necessary to perfect the right to pursue the civil remedy authorized by this section. These are not mere technical deficiencies. These deficiencies deprive American Coastal of fair notice of the alleged violations and, therefore, does not provide American Coastal with any opportunity to cure or address the alleged violations. These deficiencies are fatal to the Claimant’s CRN. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 879 (Fla. Dist. Ct. App. 2021); Heritage Corp. of S. Florida v. Nat’l Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1298 (S.D. Fla. 2008), aff’d, 361 Fed. Appx. 986 (11th Cir. 2010). Furthermore, the CRN requires the Complainant to “reference to specific policy language that is relevant to the violations, if any.” The Complainant does not cite to any policy language. Let alone any relevant to the baseless statutory violations cited to by the Insured. Without reference to the specific policy at issue or providing further details the CRN fails to put AmCoastal on notice as to the alleged violation and cannot properly respond to the CRN. Thus, the CRN is purposefully drafted in a manner which does not provide AmCoastal the required notice of the allegations or any meaningful opportunity to respond and/ or evaluate the claims being asserted. Based upon the foregoing, the CRN is insufficient on its face and should be rejected. See Talat, 753 So. 2d 1278 (Fla. 2000); Lane, 862 So. 2d 744 (Fla. 5th DCA 2003). Accordingly, the CRN is legally insufficient and must be rejected. II. FACTUAL BACKGROUND The CRN omits any of the factual history of the claim. AmCoastal denies each and every one of the alleged facts and circumstances referenced in the CRN. Below we provide the correct factual background for the Claim. On September 24, 2017, AmCoastal received notice of Insured’s Claim related to Hurricane Irma that occurred on September 10, 2017. The Insured did not provide any additional information at the time of reporting. Thereafter, AmCoastal promptly commenced its investigation. On October 12, 2017, independent field adjuster, George Joseph from VeriClaim, Inc. (the “FA”), inspected the Property on behalf of AmCoastal. During his inspection, the FA noted minor interior water damage in a few units. However, the majority of these areas appeared to be ongoing areas of damage caused by roof drainage or old repairs that are now starting to fail. He did not observe evidence of wind damage to the flat and modified roofing areas on the Property, but did see some missing tiles. Based on his inspection, AmCoastal retained building consultant Jim Adams from Young & Associates (the “BC”). The BC inspected the Property on December 18, 2017. The inspection revealed that the flat roof areas, covered with modified bitumen, were in poor condition and largely unmaintained, with wind likely causing minimal seam tears and chipped edges. The concrete tile mansard roofs exhibited minor damage from wind or debris, such as chipped or displaced tiles. None of the wind related damages observed roof exceeded 25%, so repairs are feasible under Florida building code. He observed delaminating stucco and peeling paint, indicating pre-existing issues. In sum, he concluded that the minimal were repairable. Neither the BC nor FA observed evidence of a wind created opening on the roofs or exteriors of the Property. The BC prepared an estimate based on their findings and tarping invoices. After applying the deductible, AmCoastal issued payment in the amount of $5,009.05 for the 1 location that exceeded the deducible. On May 9, 2019, AmCoastal received the Sworn Proof of Loss (“SPOL”) accompanied with estimates totaling $1,971,241.36 contemplating, inter alia, full replacement for all roofs of the buildings located on the Property. On May 21, 2019, AmCoastal promptly issued its response to the SPOL and advised that it would be reinspecting the Property. Instead of complying with AmCoastal’s request to reinspect, the Insured filed a lawsuit June 13, 2019. Thereby precluding AmCoastal from completing its investigation regarding the alleged dispute as to the amount of covered damages. Here, the facts surrounding this Claim unquestionably establish that AmCoastal acted promptly, diligently, and fairly towards the Insured throughout the entirety of the investigation and, in good faith, taken all efforts to resolve the dispute. Accordingly, AmCoastal fulfilled its duties and obligations under the policy and, importantly, always acted in good faith. AmCoastal expressly reserves all rights and/or defenses that it has under the policy and/ or Florida and Federal law. III. RESPONSE TO THE CRN’S ALLEGATIONS In response to each statutory violation alleged in the CRN, AmCoastal states as follows: • 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. Response: AmCoastal strictly denies this allegation. As indicated by the facts stated above, AmCoastal acted fairly and honestly toward the Insured at all times throughout the investigation of the claim. Here, upon completion of its investigation AmCoastal determined and confirmed that the covered damages did not exceed the deductible for all but 1 location. When the Insured disputed the coverage determination, AmCoastal attempted to continue its investigation and requested a reinspection. However, instead of complying, the Insured, in bad faith, rushed to the courthouse. Here, the facts demonstrate that AmCoastal unquestionably acted in good faith at all times. Therefore, no violations of § 624.155(1)(b)(1) have occurred. IV. CONCLUSION AmCoastal requests that the CRN be rejected for its failure to comply with Florida Statutes § 624.155 and Florida case law, as outlined above. It is clear that the CRN is procedurally deficient and substantively insufficient. Notwithstanding the CRN’s rejection, it is evident that AmCoastal has acted in good faith, with due diligence, and in accordance with the terms of the subject insurance policy and Florida Statutes with respect to the requests made by its Insured and its representatives. Here, AmCoastal complied with all obligations under the insurance policy and Florida Statutes. Throughout its investigation of the Claim, AmCoastal evaluated the claimed damages based on the information available and attempted to obtain all additional facts and information necessary to process the claim. As evidenced by the facts, AmCoastal’s actions in handling the Claim were prompt, thorough, and conducted in accordance with the subject policy and Florida law, most importantly, in good faith. In closing, AmCoastal denies each and every allegation contained in the CRN. We trust this response adequately addresses the allegations of violation alleged in the CRN. In addition, you will find a copy of the response submitted to the Florida Department of Financial Services on its website. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Best Regards, /s/Ronald A. Lacayo Ronald A. Lacayo, Esq.
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