Civil Remedy Notice of Insurer Violations
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Filing Number:     783198
Filing Accepted:  9/17/2024
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Complainant
Last/Business Name *  
GREENWOOD VILLAGE CONDOMINIUM ASSOCIATION, INC.   First Name  
Street Address * 620 GREENWOOD VILLAGE BLVD
City, State Zip * WEST MELBOURNE, FL 32904
Email Address * JP@GREENWOODVILLAGECONDOS.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GREENWOOD VILLAGE CONDOMINIUM ASSOCIATION, INC.   First Name  
Policy # * AMC-35945-04 Claim #* CLM-44314
Attorney
Attorney is Applicable
Last Name* TAYLOR First Name * KENDRA Initial J
Street Address* 280 WEST CANTON AVE, STE 330
City, State Zip* WINTER PARK , FL 32789
Email Address * KTAYLOR@ABLAWFL.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):* J. MARSHALL PEMBERTON SR. COMPLEX CLAIMS ADVISOR & ROY DIDION, FIELD ADJUSTER
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Other : Failure to Properly Investigate Claim and with due Regard to Insured's Interest
Other : Failure to Acknowledge and Act Promptly to Communications Regarding the Claim
Other : Failure to Pay the Claim in Full
Other : Failure to pay the fair value of the insurance claim
Other : Placing the financial interest of the Insurer over its obligation to the policyholder
Other : Failure to work in consultation with the policyholder to resolve the claim
Unsatisfactory Settlement Offer
* 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(f) 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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

A certified copy of the policy is not in the Insureds’ possession, but based on information and belief, the following policy provisions are relevant to this civil remedy notice. Condominium Association Coverage Form CP 00 17 0607 - Section A.1 - Coverages – We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any covered Cause of Loss. Condominium Association Coverage Form CP 00 17 0607 - Section E.4 – Loss Payment
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

American Coastal Insurance Company (“AMCOASTAL”) has committed the following in handling the Insureds’ claim as defined by the Policy: 1. Failure to act in due diligence and good faith to resolve, adjust or settle claims 2. Placing the financial interest of the Insurer before that of the Insured; 3. Looking for ways to deny or delay benefit payments and otherwise “low ball” or “stonewall” claims; 4. Conducting an inadequate investigation of the insured property; 5. Failure to pay the claim in full; 6. Failure to properly investigate the claim; 7. Failure to properly adjust the Loss; 8. Failure to properly train, evaluate and manage adjusters; 9. The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to promptly and fairly investigate, adjust and pay full benefits available to all beneficiaries. The Insurer may have failed to adopt proper standards because full payment and prompt payment for the loss is not occurring causing work to be halted several times. This complaint is made on behalf of Greenwood Village Condominium Association, Inc. (“Insured”). In consideration of the premium paid to it by the Insured, AMCOASTAL issued an Insurance Policy No.: AMC-35945-04 covering the Property. On or about April 26, 2023, while the Policy was in full force and effect, the Insured suffered a hail loss at the Insured Properties (“the Property”). The loss caused direct physical damage to the Property including but not limited to damage to the exterior siding; patio screening; windows; shingle and metal roofing systems of the buildings; and fences on the Property. AMCOASTAL through its Claims Administrator Sedgwick assigned claim number CLM-44314 to the loss. Sedgwick assigned J. Marshall Pemberton, Sr., AIC, PCLA, LPCS - Complex Claims Advisor and Executive General Adjuster, Roy F. Didion to the Claim. The Insured’s insured property consists of thirty-seven locations/buildings at the following addresses: Location 1 - Building 1: 605 - 607 Greenwood Village Blvd; Location 2 - Building 2: 9000 - 9002 Brighton Court; Location 3 - Building 3: 9010 – 9012 Brighton Court; Location 4 - Building 4: 9020 - 9022 Brighton Court; Location 5 - Building 5: 9000 - 9002 Wedgewood Court; Location 6 - Building 6: 9005 – 9007 Wedgewood Court; Location 7 - Building 7: 610- 612 Greenwood Village Blvd; Location 8 - Building 9: 9010 – 9012 York Lane; Location 9 - Building 10: 9020 – 9022 York Lane; Location 10 - Building 11: 9025 – 9027 York Lane; Location 11 - Building 12: 9030 – 9032 York Lane; Location 12 - Building 13: 9035 -9037 York Lane; Location 13 - Building 14: 615 – 617 Greenwood Village Blvd; Location 14 - Building 15: 9045 – 9047 York Lane; Location 15 - Building 16: 9040 – 9042 York Lane; Location 16 - Building 17: 625 – 627 Greenwood Village Blvd; Location 17 - Building 18: 605 – 607 St Albans Court; Location 18 - Building 19: 610 – 612 St. Albans Court; Location 19 - Building 20: 9000 - 9002 Manchester Lane; Location 20 - Building 21: 9015 – 9017 Manchester Lane; Location 21 - Building 22: 9025 – 9027 Manchester Lane; Location 22 - Building 23: 9030 – 9032 Manchester Lane; Location 23 - Building 24: 9035 – 9037 Manchester Lane; Location 24 - Building 25: 9040 – 9042 Manchester Lane; Location 25 - Building 26: 635 – 637 Greenwood Village Blvd; Location 26 - Building 27: 9005 – 9007 Scarsdale Court; Location 27 - Building 28: 9015 – 9017 Scarsdale Court; Location 28 - Building 29: 9010 – 9012 Scarsdale Court; Location 29 - Building 31: 630 – 632 Greenwood Village Blvd; Location 30 - Building 32: 9015 – 9017 Wedgewood Place; Location 31 - Building 33: 9010 – 9012 Wedgewood Place; Location 32 – Building 8: 9000 York Lane; Location 33 – Building 30: 9000 Scarsdale Court; Location 34 – Clubhouse: 620 Greenwood Village Blvd; Location 35 – Guard Shack; Location 36 – Storage Shed; and Location 37 – Pool Shed On or about May 10, 2023, the Insured retained Stone Claims Group a public adjuster to assist with the damages. The Insured timely notified AMCOASTAL of its claim for hail damages to the shingle and metal roofing systems, exterior siding, patio screening, and windows and was assigned claim number CLM - 44314. The hail damages were caused due to a storm occurring on April 26, 2023. During the course of AMCOASTAL ’s investigation, the Insureds made their property available for inspection, provided facts and information surrounding the loss, and complied with AMCOASTAL ’s adjustment of the claim. The Insured timely submitted the following estimates of damages to the Claims Administrator Sedgwick working on behalf of AMCOASTAL on the following dates: • August 24, 2023 estimate and proof of loss $7,119,446.61 • November 6, 20223 estimate and proof of loss $5,737,379.71 Although AMCOASTAL acknowledged the Insured’s property was damaged by the hail, AMCOASTAL inexplicably underpaid the damages claimed. On September 11, 2023 provided an estimate of damages prepared by Field Adjuster Roy Didion of Engle Martin. Mr. Didion’s estimate is $2,908,503.89, less the $10,000.00 policy deductible, recoverable depreciation in the amount of $648,327.21, and items which fall under Ordinance or Law Coverage in the amount of $132,306.72. The recoverable depreciation amount shown is based on the age and condition of the property at the time of inspection. The items which fall under the Ordinance and Law Coverage will be paid when incurred. The enclosed initial payment was issued in the amount of $2,117,869.96 on an actual cash basis until repairs are completed. AMCOASTAL came to its coverage determination by ignoring relevant facts and information provided by the Insured and their public adjuster that established all the damages to the property. Most concerning, AMCOASTAL and its representatives intentionally downplayed and misrepresented the scope of the damages. AMCOASTAL also omitted key facts from its coverage decision and misapplied exclusions to minimize its financial exposure in the claim. It has become a general business practice of AMCOASTAL to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for AMCOASTAL to arbitrarily undervalue claims and delay claims without conducting reasonable investigations based upon information and evidence available to it. It is also a general business practice of AMCOASTAL to not respond to claim communications, to not explain what information is necessary to process the claim, and to not explain why benefits are continuing to be withheld under the policy. AMCOASTAL ’s actions are part of a broader scheme to delay claims and avoid issuing payment that AMCOASTAL knows is owed to its insureds. AMCOASTAL failed to timely make a claims determination on the Insured’s claim. Under section 627.70131, AMCOASTAL , has ninety (90) days from the date it receives notice of a claim to make claims determination. AMCOASTAL took over 90 days to make a claims determination where they delayed the claim; failed to properly adjust the claim, therefore underpaying the claim to the detriment of the Insured. In Florida, the work of adjusting insurance claims engages the Public Trust. AMCOASTAL breached this duty in its failure to properly, timely, and fairly adjust its Insured’s claim of loss. AMCOASTAL ’s handling and adjustment of its Insureds’ claim of loss and the conduct of the adjusters, supervisors, management and individuals associated with or retained by AMCOASTAL in this claim to date is evidence that AMCOASTAL has failed to create and implement adequate guidelines for the (1) the proper investigation and evaluation of claims; and (2) the training and supervision of employees, resulting in the statutory violations set forth above. AMCOASTAL has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds insurance claim for damages. To date, notwithstanding the Insured’s pleas for assistance, AMCOASTAL has refused to pay the full amount of its Insured’s claim. On November 28, 2023, the Insured entered into a contract with Stratus Construction & Roofing, LLC, a reputable local general contractor who is known for competitive pricing in the central Florida market with the financial and local resources to perform a project of this size in a timely manner, to conduct the repairs needed to the property. Pursuant to Ceballo v. Citizens Property Ins. Corp., 967 So.2d 811 (Fla. 2007), “that ‘to incur’ means to become liable for the expense, but not necessarily to have actually expended it.” When the Insured entered into a contract with Stratus they became liable for the expense of the roof replacements, siding repairs and other work needed to return the Property to its pre-loss condition. Additionally, the continued delays from AMCOASTAL on releasing payments, recoverable depreciation, and ordinance and law caused Stratus Roofing to complete the shingle roofs and shut the job down due to a lack of funds. Additionally, the contractors’ supplier is in the process of placing a lien on the property. Six months later on March 27, 2024 AMCOASTAL issued another undisputed supplemental payment based upon an estimate of repairs prepared by the Field Adjuster in the amount of $3,453,216.20, Less the policy deductible of $10,000.00, less recoverable depreciation of $776,967.17, less ordinance and law $136,438.53, and less prior payment of $2,117,869.96. The enclosed ACV payment in the amount of $411,940.51 is being made on an actual cash basis until the repairs are completed or the damaged items are replaced. Finally, July 1, 2024 the AMCOASTAL issued another undisputed payment based upon the Field Adjusters estimate for the siding in the amount of $79,343.48 on an actual cash basis until the repairs are completed, or the damaged items are replaced. If the cost of repair or replacement exceeds the actual cash value payment enclosed, please contact AMCOASTAL. AMCOASTAL has failed to properly investigate the claim and delayed the claim. • On March 30, 2024 AMCOASTAL representative requested documentation for recoverable depreciation • On June 4, 2024, Stone Claims provided the following documentation • Contract from the contractor that has been retained for repairs. • A reasonable detailed Final Invoice and proof of payment from said contractor. • A Certificate of completion prepared by the contractor. • A certificate of satisfaction of work performed, signed by the Insured. • On June 11, 2024 AMCOASTAL representative emailed “please note that the loss is under review an we hope to have a solid status in the near future.” Carrier emailed again “unless I overlooked I cannot locate proof of payments” • On June 12, 2024 Stone Claims again provided email with proof of payments, “Here is the proof of payments, the Insured is needing the recoverable depreciation, withheld against the roof repairs, to be released as soon as possible since the roof repairs are completed and the agreement identifying the total cost of the roof repairs has been provided. The Insured needs the withheld proceeds released to pay their contractor for the completed repairs, allowing the remaining repairs to continue without unnecessary delays or exposure. Please advise a reasonable timeline so Stratus can close the billing out with the invoice from the supplemental items as they are currently having to finance the entire project because the Association does not have the funds, beyond their deductible responsibility, to pay the balance of the current completed contract.” • On June 20, 2024 Stone Claims again emailed proof of payments and wire transfers to the Carrier. • On July 8, 2024, Amcoastal requested Stone Claims to provide a spreadsheet of the paid invoices. • On July 13, 2024, Amcoastal advised that “following several conversations with our field adjuster, Roy Didion and internal management we will be submitting our recommendations to the carrier next week.” • On July 21, 2024, an Amcoastal representative Sedgwick advised “we await the carrier review and we will advise you upon receipt.” • On August 22, 2024, Stone Claims advised Amcoastal “I attached the general contractor’s invoices (7) for the roof repairs and the insured’s proof of payments (6) made to the general contractor. I attached the proof of payment to each invoice. The insured made one $500,000.00 transfer of funds for the contractor’s invoices totaling $290,000.00 and $210,000.00. The Association still owes the contractor $2,933,189.53 for the completed roof repairs after exhausting the insurance proceeds released at this time.” • On August 23, 2024, Amcoastal advised “will further review and prepare for submission to the carrier” • As of September 13, 2024, there have been no supplemental payments have been made or any payments issued on the outstanding recoverable depreciation. The entire purpose of insurance is to indemnify the insured of a covered loss. Despite this, AMCOASTAL has failed to issue any additional supplemental payment to the Insured despite evidence that it vastly underpaid the Insured’s claim..To date, AMCOASTAL has failed or refused to provide the Insured with all the insurance benefits due and owing, despite knowing that the Insured has sustained covered damages to the Insured’s property. Despite the Insureds repeated pleas, AMCOASTAL has not tendered the full amount needed to restore the property to its pre-loss condition under the Policy and due and owing under the Policy. As AMCOASTAL must admit, every insurance policy has an implied duty of good faith and fair dealing. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealing encompass qualities of decency and humanity inherent in the responsibilities of a fiduciary. AMCOASTAL is bound to conduct itself with the utmost good faither for the benefit of the Insured. However, AMCOASTAL has failed to comply with the obligations under the Policy in connection with this claim and has never looked at the claim or the insurance contract with good faith and fair dealing. Instead, AMCOASTAL has delayed the claim and not paid all money due and owing under the Policy to the detriment of the Insured. AMCOASTAL ’s conduct has been reckless and unfair to the Insured. This is evidenced by the repeated delays of AMCOASTAL in communicating, adjusting, evaluating, and paying the claim. Stone Claims advised Amcoastal through Sedgewick the following: “Thanks for sending the supplemental estimate. We reviewed the supplement and noticed it is still based on AKG Home Inspector's quote. After briefly researching SunBiz and the BBB, we're not sure why this company or their quote would be used to support either position regarding any claim. Especially after we provided itemized quotes from a reputable local general contractor who is known for competitive pricing in the central Florida market with the financial and local resources to perform a project of this size in a timely manner. The Insured has commissioned this GC to perform all of the repairs including the interior damage. The limitations for the GC to file a lien against the completed roofs is fast approaching and he will have no choice but to place several lines on the property unless he receives a substantial payment. The GC made an offer to avoid the liens from being filed on the completed roofs but the Association does not have enough in reserves to meet these demands on their own without the carrier releasing the withheld claims proceeds on the roofs. We also noticed the carrier's estimate and AKG's quote has to "Install new 1-30lb base sheet & tin cap to code". The only roof areas that have a "base sheet" are the low slope roof sections. The Insured's damaged shingled roofs had a self-adhering secondary moisture barrier which was documented within the wind mitigation reports. These reports should already be in the claim file but for your convenience, I sent you an invite to these reports. In case the invite wasn't received, here is a ink to our shared drive for the wind mitigation reports: https://drive.google.com/drive/folders/1WIyTqMKCT_v0abWV9EBzTqxhuT81bE1 j?usp=drive_link. We can address this shortage once the carrier responds to the request to release the recoverable depreciation on the completed and paid roof repairs unless this week's meeting did not occur. I also wanted to update you on our findings after speaking with the Building Department. We attempted to arrange a meeting with a City of West Melbourne's Building Official to help clarify the Florida Building Codes applicable to the Insured's property as it related to the repairs of various siding types, vapor barrier, insulation, or otherwise related to the exterior wall's envelope. Dan Ferry, who is the Building Official assigned to the permits for the roof and siding repairs at Greenwood Village Condos. We were able to meet with him but we were able to speak with him via phone and explained the situation, without providing identifying information or referencing the Insured's property. But we provided him with information in reference to a two-story multi-family building with the same exterior wall materials conditions, and issues associated with re-roofing building similar to the Insured’s property. He confirmed, the municipality works on the Florida Building Code 2023 and the City does not have any building codes that would supersede Florida Building Codes applicable to our Insured’s buildings. He said the exterior cladding repairs cannot be done in compliance with 2023 Florida Building Codes unless the repairs include installing the missing materials or replacing the deficient materials manipulated to perform the repairs, i.e. sheathing, insulation, flashing, vapor barrier, etc. Mr. Ferry went on to explain that any missing sheathing, insulation, single layer vapor barrier, and associated flashing MUST be installed when opening the envelope of the exterior wall. Also, if any materials or assemblies have to be manipulated to perform the repairs, these items must also be in compliance with 2023 FBC. This requirement includes anything the contractor has to remove or manipulate to perform the permitted repair. Since some windows will need to be removed to perform the siding repairs, this condition also affects the existing windows installed in the wall areas to be repaired. The contractor will need to replace the windows, he removes to perform the exterior repairs, if the windows are not compliance with 2023 FBC. The wall sheathing and vapor barrier is located behind the siding on the exterior wall areas to be repaired and must be terminated inside the windows’ wall openings which requires the windows to be removed. Since the windows must be removed to perform the required exterior repairs, the implication of the 2023 FBC is applicable to the windows to be removed. This requires the windows to be installed to be compliance with 2023 FBC regardless if they were damaged. There was one other issue we addressed with Mr. Ferry which was regarding the buildings with damaged vinyl siding. The majority of these buildings have multiple elevations with hail damaged vinyl siding which is installed over an early version of multi-material construction sheathing (paper and foil) that is no longer allowed to be used or repaired in Florida. Mr. Ferry also informed us, if the siding repair encompasses more than 51% of the exterior wall surface, the entire building must be made to comply with current FBC. This will entail removal of ALL vinyl siding and replacement of water damaged exterior wall insulation and correction of any framing issues that would be visible during the inspection of the insulation and/or vapor barrier. Then install the vapor barrier, sheathing, moisture barrier and flashing (where required), then install new vinyl siding on the entire building. The only unknown regarding the vinyl siding is how many windows the contractor will be required to replace for compliance since some windows on these buildings appear to be of newer construction than others. We are working with the Insured to provide a list of units where water damage has occurred and we'll provide you this list once compiled. Once we know which units were damaged, we'll inspect them with the GC, property manager, and the Association. We will document the additional damage and provide this documentation to you. We will also let you know the availability for the interior inspections so the Insurer can have a representative attend. We'll also provide the GC's quote to repair the interior damages that are the Association's responsibility.” AMCOASTAL X’s refusal to fully pay the Insured’s claim is a violation of Florida Statutes. The Insured was and is still forced to expend out of pocket monies to compel AMCOASTAL to honor its obligations under the insurance policy and pay all the insurance proceeds due and owing. AMCOASTAL has refuses and/or failed to cooperate and/or “Adjust the Loss” by cooperating with the Insured during the claims adjustment process in compliance with the Policy’s “Loss Payment” and “Settlement” provision. AMCOASTAL has breached this provision of the Policy. AMCOASTAL has a contractual obligation to conduct a thorough investigation, and not ignore evidence that would support the Insured’s claim and claim of damages. AMCOASTAL has breached these provisions of the Policy. AMCOASTAL has a contractual obligation not to look the other way when confronted with facts revealing the possibility of coverage and not to resist reasonable interpretations of its Policy; this is a breach of the Policy. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss between an insurer and an Insured. Florida Statute Section 624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent in the fact that payment must be made timely and promptly so that the Insured may mitigate the damages and restore the Property to the pre-loss condition as quickly as possible. AMCOASTAL has breached this duty. AMCOASTAL has refused and/or failed to tender all insurance proceeds to the Insured upon demand. AMCOASTAL ’s refusal and/or failure to settle the insurance claim when all circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrongful conduct. Furthermore, the Insured contends that AMCOASTAL ’s adjusters and/or representatives financially benefit from such wrongful conduct. Therefore, to cure the defects outlined in this Civil Remedy Notice, AMCOASTAL X must: AMCOASTAL must admit through written acknowledgment that the loss is fully covered under the Policy AMCOASTAL must create and implement adequate guidelines for claims handling, ensuring: (1) the proper investigation and evaluation of claims; and (2) the training and supervision of employees. These guidelines must be adequate to avoid future statutory violations, and to stop future Insureds from being treated unfairly and wrongfully; AMCOASTAL must assist the Insured in mitigating Insured’s damages; AMCOASTAL must properly, thoroughly, and promptly investigate the Insured’s Property and tender payment to return the Property to its pre-loss condition; AMCOASTAL must immediately tender all undisputed insurance proceeds to the Insured while continuing to adjust the loss with the Insured; AMCOASTAL must immediately release the recoverable depreciation for the completed repairs and any ordinance and law. Ordinance and law is incurred when a contract is signed with a general contractor not when repairs are completed. AMCOASTAL must act fairly and honestly towards the Insured and with due regard for the Insued’s best interests in attempting to settle the Insured’s claim; AMCOASTAL must pay all attorney’s fees and costs insured incurred as a result of the above actions; AMCOASTAL must immediately tender all insurance benefits due and owing to the Insured under the Policy pursuant to the relevant policy provisions provided therein that would reasonably place the insured back to the pre-loss condition, including, but not limited to all interest due and owing under applicable Florida Statutes; AMCOASTAL must pay the Insured the fair value of the insurance claim; The Insured has one signed contract with Stratus Roofing for the roofs repairs/replacements for $5,463,000.00 and has another signed contract with Stratus Roofing for the siding for $1,379,000.00. The written acknowledgement and any payment should be issued to the Insured’s counsel, Kendra J. Taylor, Esq., at 280 W. Canton Ave, Ste 330, Winter Park, FL 32789.
Comments
User Id Date Added Comment
ccambo@camboferry.com 11-15-2024 November 15, 2024 Via E-Mail Only Greenwood Village Condominium Association, Inc. c/o Kendra J. Taylor, Esq. AriasBosinger, PLLC 280 W. Canton Ave. Ste. 330 Winter Park, FL 32789 ktaylor@ablawfl.com RE: Matter: Greenwood Village Condominium Association, Inc. Claim Number: 4205469 Policy Number: AMC-35945-04 DFS Filing Number: 783198 Dear Greenwood Village Condominium Association, Inc.: As you know, my firm has been retained to represent American Coastal Insurance Company (“American Coastal” or “AmCoastal”) in the above-referenced matter. Please allow this letter to acknowledge that American Coastal is in receipt of the Civil Remedy Notice of Insurer Violations bearing Filing No. 783198 (the “Notice” or the “CRN”) filed on behalf of Greenwood Village Condominium Association, Inc. (the “Insured”). The notice lists a claim number of CLM-44314, but this is not the relevant claim number for the subject claim. The correct claim number is 4205469. The Notice is void because it is legally invalid. Beyond that, the allegations in the Notice have no merit. I. The Civil Remedy Notice is legally invalid. The filing of a valid Civil Remedy Notice is a condition precedent to an action brought pursuant to section 624.155, Florida Statutes. Talat Enter., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Because the statute is in derogation of the common law, it must be strictly construed. Id. “[A]ny statute in derogation of the common law requires strict compliance with its provisions by one seeking to avail himself of its benefits.” Florida Steel Corp. v. Adaptable Devs., Inc., 503 So. 2d 1232, 1234 (Fla. 1986). Section 624.155, Florida Statutes, requires a civil remedy notice to provide specific information to put the insurer on notice of the alleged violation. Additionally, a civil remedy notice must be “specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days.” Valenti v. Unum Life Ins. Co. of Am., 8:04CV1615T-30TGW, 2006 WL 1627276, at *2 (M.D. Fla. 2006). Here, the Notice is invalid because it does not contain all of the information required by section 624.155. Also, it is invalid because it lacks sufficient specificity to provide notice to American Coastal of the alleged wrongdoing, as discussed below. First, the CRN does not provide any specific supporting facts and merely makes conclusory statements. No specific facts identifying what, if anything, American Coastal did or failed to do with regard to the claim were provided. Instead, the allegations are mere self-serving and conclusory statements without substance or relation to any alleged violation. For example, the Notice alleges, “AMCOASTAL also omitted key facts from its coverage decision and misapplied exclusions to minimize its financial exposure in the claim.” Despite this allegation, the insured in their Notice acknowledges American Coastal has issued payments in the amount of $2,117,869.96, $411,940.51, and $79,343.48. Further, based upon all documentation received to date from the insured, it does not appear the Insured has incurred costs in excess of American Coastal’s payments. This undermines the purpose of the CRN requirement preventing American Coastal from investigating and resolving any of the alleged violations. The failure to provide any specific supporting facts for the allegations renders the CRN invalid. Second, the CRN fails to relate the specific policy language to the alleged violation as required by Fla. Stat. §624.155(3)(b)4. In fact, with regard to the policy language relevant to the alleged violation, the CRN simply refers to form CP 00 17 0607 – Section A. 1 – Coverages and Section E.4 – Loss Payment. Additionally, the CRN falsely claims that the insured was not provided a certified copy of the policy, when, in fact, American Coastal sent a certified copy of the policy to the insured’s counsel on June 1, 2023. Pursuant to Fla. Stat. §624.155(3)(b)4, the CRN must cite to the specific policy language that is relevant to the alleged violations. However, the failure to advise of any policy provision in dispute prevents American Coastal from addressing any issues regarding the policy the Complainant alleges to have been violated, which is the underlying purpose of Fla. Stat. §624.155(3)(b)4. The CRN, therefore, is statutorily deficient because it does not comply with the requirements set forth in Fla. Stat. §624.155(3)(b)4. Third, the boilerplate CRN lacks sufficient specificity to provide notice of the alleged bad-faith conduct. The CRN lists nine (9) different statutes which American Coastal allegedly violated. However, the CRN fails to provide any relevant facts supporting the alleged violations or relating these alleged violations to the nine (9) cited statutes. Because the Civil Remedy Notice fails to relate the cited statutes to any facts explaining why the Insured believes American Coastal violated the statutes, American Coastal is unable to properly respond, and the CRN is invalid and should be rejected and returned. Finally, the Notice is invalid because it conditions American Coastal’s ability to “cure” by requiring American Coastal to pay for things and do things that are not required under Talat. In Talat, the Florida Supreme Court said that to “cure” a Notice, an insurer must pay the amount owed pursuant to the express terms and conditions of the policy.” However, the Notice here demands payment of money that is not owed pursuant to the policy, such as attorney’s fees and costs. It is improper to demand such items as a cure for a civil remedy notice. Talat, 753 So. 2d at 1282–83; see also Francois v. Illinois Nat. Ins. Co., 01-CV-8070, 2002 WL 33760405, at *4 (S.D. Fla. 2002) aff'd, 49 Fed. Appx. 290 (11th Cir. 2002) (discussing whether a demand of attorneys’ fees in a civil remedy notice is proper). As such, the CRN is invalid and should be rejected and returned. Because the CRN fails to comply with the information requirements promulgated by the Department of Financial Services, it is legally invalid. See Pin-Pon Corp. v. Landmark Ins. Co., 2020 U.S. Dist. LEXIS 100072, *7 (S.D. Fla., June 5, 2020); Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021). Again, in serving this response, American Coastal reserves all rights under Florida law to be served with a properly completed and statutorily compliant CRN. As the CRN fails to strictly comply with the requirements of section 624.155, Florida Statutes, it is legally insufficient and should be rejected. II. The Civil Remedy Notice Lacks Merit. The Notice also lacks merit. On April 27, 2023, the insured reported the subject claim for wind/hail damage with a reported date of loss of April 26, 2023. The affected risk is 33 condominium buildings, 1 Club House building, 1 Pool Shed building, 1 Storage Shed building, and 1 Gate House/Guard Shack building. The condominium buildings are two-story, frame and stucco structures with architectural shingle roofs. Each building has units that are individually owned. The buildings have various numbers of units and square footages and were built from 1981 – 1993. On May 1, 2023, the account manager on behalf of AmCoastal attempted to call the insured to discuss the claim and left a voicemail. The account manager then emailed the insured to provide the contact information and to advise that a field adjuster, Rich Wallace of Engle Martin, had been assigned to inspect the property. On May 2, 2023, the account manager for AmCoastal followed up and left another voicemail and wrote to the insured to request a call back. Instead of calling back, AmCoastal received a letter of representation from counsel for the insured on May 12, 2023. On May 15, 2023, AmCoastal received correspondence from the insured’s public adjuster, Stone Claims, advising that they have inspected the property and will make themselves available for another inspection with AmCoastal. On June 1, 2023, AmCoastal sent the insured’s counsel a certified copy of the subject policy. On June 9, 2023, AmCoastal sent a Reservation of Rights and Request for Information letter to the insured, seeking documentation and information supporting the claim, as well as the completion of the Sworn Proof of Loss. On June 27, 2023, the field adjuster wrote to the insured’s counsel to attempt to coordinate the detailed inspection of all buildings. Specifically, the field adjuster noted that he and his team needed to inspect the roofs, exterior, and top floor of the interiors of all buildings to ensure no interior leaks have developed, unless the insured advises otherwise. He offered the week of July 17, 2023 and/or July 24, 2023 for the inspection. Additionally, the field adjuster followed up on the outstanding request for information and documentation from the insured. On June 29, 2023, the insured’s public adjuster confirmed availability for the week of July 24, 2023 for the inspection, and advised that he is working with the insured to gather the requested information. On July 14, 2023, the insured’s public adjuster sent an email providing a Google Drive link with some, but not all, of the responsive documents that were requested by American Coastal. He also requested an extension of time to submit the Sworn Proof of Loss on behalf of the Insured. On July 20, 2023, the insured signed the Sworn Proof of Loss, but stated that the amount claimed was “TBD.” The public adjuster submitted the Sworn Proof of Loss, and also provided an updated Google Drive link with an updated list of damaged units. He also noted that he will submit a revised Sworn Proof of Loss once his investigation is complete. On August 21, 2023, the public adjuster wrote to AmCoastal to advise that they have completed their estimate, which has been submitted to the Board of Directors for the Insured for their review. On August 24, 2023, the insured submitted a Sworn Statement in Proof of Loss with an amount claimed of $7,119,446.61 (RCV). On August 31, 2023, AmCoastal evaluated the field adjuster’s report, which confirmed hail damage to the roofs of the subject property. The field adjuster recommended full roof replacements, as well as replacement of the gutters, downspouts and exterior repairs to the building. In light of the field adjuster’s findings, as well as the documentation provided from the insured, American Coastal opened coverage for the loss. Specifically, on September 11, 2023, AmCoastal wrote to the insured, in care of its counsel, to open coverage for the claim and to advise that the following claim payment was being issued: Replacement Cost Value: $ 2,908,503.89 Less Depreciation: $ 648,327.21 Less Ordinance or Law: $ 132,306.72 Less Deductible: $ 10,000.00 Net Claim Payment: $ 2,117,869.96 The September 11, 2023 claim payment letter explained the process for the release of recoverable depreciation and noted that Ordinance or Law coverage will be paid when it is incurred. On September 12, 2023, the insured’s public adjuster wrote to confirm receipt of the settlement letter and field adjuster’s estimate. On September 25, 2023, AmCoastal wrote to counsel for the insured and their public adjuster following a phone conference regarding the errant line items in the public adjuster’s estimate. There were numerous discrepancies identified, and the public adjuster agreed to provide a revised estimate. On October 2, 2023, the insured’s public adjuster submitted a revised estimate totaling $5,743,521.62 with updated document production. The public adjuster made the following concessions and comments: • Stone Claims Group is replacing all roof sheeting. • Replacing all sheeting with roof's that have self-adhering underlayment see wind mitigation reports. We did not re-deck where felt underlayment is found to exist. • Stone Claims Group is replacing painting all the siding on the chimney and roof walls. • We did not replace any siding due to Hail damage, but we did include to clean, repair & paint with Hail damage. But we did include to manipulate siding on the chimneys, wall areas above roof lines to replace roof/wall flashing. • Stone Claims Group is claiming additional charge for high roof (2 stories or greater), all roofs are accessible at 1 story. • Majority of the roofs are 2 stories, see photo reports link. • Stone Claims Group is pressure washing and painting all buildings. • See attached photo report link for each building with Hail damage to the exterior. • Stone Claims Group has charges for traffic control. • Traffic control is being used to protect and re-direct residents & visitors from hazardous areas where the risk of falling debris exists. To ensure compliance with all OSHA requirements. • Stone Claims Group has charges for a Boom or spider lift and scaffolding for every building. • The lifts are to address 2nd story exterior & replace metal balcony roofs. Due to site limitations scaffolding must be used to access 2nd story exterior balcony attached roof's where lifts cannot access due to grade, trees etc. • Stone Claims Group has Delivery charges for each building. • We applied those charges to each building to insure all lines of coverage share in this expense. • Stone Claims Group is claiming replacement of several sections of fencing. • Removed from estimate as we believe there is no coverage. • Stone Claims Group has $42,500.00 in Permits and Fees • We agreed with Engle Martin on taxes, insurance, permits & fees $600.00 for each building. The balance for the general conditions is disposal, temp facilities and supervision. On November 1, 2023, AmCoastal wrote to the insured’s attorney to advise that the field adjuster was in the process of reviewing the revised estimate, supporting documentation, and will determine whether a supplemental payment is owed. On November 6, 2023, the insured’s public adjuster emailed American Coastal providing an updated Sworn Proof of Loss totaling $5,747,379.71 executed by the insured on November 6, 2023. On November 8, 2023, AmCoastal responded to the revised Sworn Proof of Loss, acknowledging receipt of same and noting that the amount of the loss and amount of the claim in the proof of loss has not been established or agreed upon. On December 18, 2023, AmCoastal wrote to the insured’s public adjuster to advise that an expert has been retained to further review the loss. On February 2, 2024, the insured’s public adjuster emailed American Coastal notingthe repairs to the subject property have not been completed but the Association has retained a contractor to perform the repairs and providing supporting documentation from this contractor. On March 15, 2024, AmCoastal issued a net supplemental payment totaling $411,940.51 after accounting for recoverable depreciation, Ordinance and Law, the applicable deductible, and prior payments. Also included in that correspondence was a Reservation of Rights and Request for Information seeking documentation and information reflecting the actual expenses incurred and proof of payment. Ultimately, both a general contractor and an engineer inspected the property on behalf of American Coastal. Following the completion of the inspections and their reports. The roofs in question were replaced prior to SEA Engineering’s inspection on April 12, 2024. American Coastal followed up over the course of the next following months seeking clarification and documentation confirming the amounts paid and incurred for the roof replacements and repairs. On July 1, 2024, American Coastal issued a net supplemental claim payment totaling $79,343.48. Although substantial documentation from the insured had been submitted, the actual amounts incurred for the roof replacements was not confirmed via this documentation. On July 2, 2024, American Coastal wrote to the insured’s public adjuster to request documentation that has not previously been submitted to confirm the amounts actually paid and incurred for the roof replacements. On July 19, 2024, the public adjuster wrote to acknowledge receipt of the supplemental payment and registered various grievances against the general contractor retained by AmCoastal to prepare the estimate that formed the basis of the July 1, 2024 supplemental payment. The public adjuster then advised that the Association had retained a general contractor to perform all the repairs, including interior damage. The public adjuster advised that the General Contractor they retained has threatened to file a lien on the property “unless he receives substantial payment.” The public adjuster requested that the recoverable depreciation be released for the roofs. With respect to the exterior repairs to the siding, the public adjuster advised that they had spoken with Dan Ferry, the Building Official for the City of West Melbourne Building Department, to clarify code issues. According to the public adjuster, Mr. Ferry advised that exterior cladding repairs cannot be done in compliance with 2023 Florida Building Codes unless the repairs include installing the missing materials or replacing the deficient materials manipulated to perform the repairs, i.e. sheathing, insulation, flashing, vapor barrier, etc. Mr. Ferry went on to explain that any missing sheathing, insulation, single layer vapor barrier, and associated flashing MUST be installed when opening the envelope of the exterior wall. Also, if any materials or assemblies have to be manipulated to perform the repairs, these items must also be in compliance with 2023 FBC. The public adjuster went on to claim that this means that the contractor will need to replace all windows he removes to perform the exterior repairs. Additionally, the public adjuster stated that Mr. Ferry also discussed the damaged vinyl siding on the buildings. Further, the email alludes to interior units being claimed as damaged and that a list of those allegedly damaged units would be forthcoming. Instead of providing that documentation, on September 17, 2024, the subject Civil Remedy Notice with filing number 783198 was filed with the Florida Department of Financial Services on behalf of the Insured. At the time this CRN was filed, the Insured or their representatives had not provided any documentation showing the Insured has incurred costs/expenses in excess of American Coastal’s prior payments. On September 24, 2024, the undersigned sent a letter acknowledging the CRN and requesting clarification on the amounts actually spent on the repairs and included a request for information seeking supporting documentation. In addition, in that correspondence, AmCoastal requested mediation to attempt amicably resolve this claim. No response was received to this correspondence. On October 14, 2024, the undersigned followed up on its September 24, 2024 correspondence seeking clarification on the amounts actually spent in the repairs, the request for information, and the request for mediation. In fact, the undersigned followed up on these requests on October 15, 2024, October 17, 2024, and October 21, 2024. On Wednesday, October 23, 2024, counsel for the insured advised that she had received all the responsive documents from the Claimant, but that she needed to download them individually and she anticipated getting this accomplished by the end of the week. No response or documentation was provided by the end of that week, which was October 25, 2024. Thus, the undersigned again followed up on November 1, 2024, November 4, 2024, and November 8, 2024. It was not until Saturday, November 9, 2024, which was 54 days after the CRN was filed, that your counsel sent counsel for AmCoastal an email containing a dropbox link of voluminous documentation consisting of thousands of pages of documents claiming to be responsive to our requests. It was not until November 13, 2024 that counsel for the insured finally responded to provide proposed dates for mediation that of course would occur long after the expiration of this CRN. In light of the significant delays above and non-responsiveness, it is clear that the Claimant and its counsel were simply ignoring AmCoastal’s legitimate requests for information and mediation to run out the clock on the cure period and prevent and preclude American Coastal from attempting to amicably resolve this claim and address the concerns raised in the Civil Remedy notice before the expiration of same. Such gamesmanship and delay tactics serve no legitimate purpose except obfuscate, delay and appears to be obvious attempt to set up bad faith lawsuit against American Coastal and instead of actually attempting to resolve this claim pursuant to the policy and the law. While we have received substantial documentation from you, the documentation provided contains numerous inconsistencies. It is unclear whether a balance remains for any payments still owed to Stratus Roofing for their repairs and work to the property. It is unclear what amounts were actually spent in the repair or replacement of the damaged property. Although AmCoastal requested copies of the actual permits and permitting records themselves (among other things), the actual permits themselves were not provided. Instead, a subfolder of the November 9, 2024 document production titled “12. What amounts you believe are due and owing and how you calculated such amounts,” contained an excel spreadsheet dated 10/4/2024 and PDF dated 10/4/24. The excel spreadsheet and PDF contained a list of 68 permits (without any identifying permit information) that were allegedly pulled for the subject property to re-roof the buildings. The excel spreadsheet contained a summary of the work completed by work type totaling $5,815,402.31, as well as an alleged total job pricing with siding replacement of $7,102.470.31, but no other corroborating information or documentation to substantiate the information was contained in the spreadsheet or PDF. We also reviewed a document titled “Certificate of Completion” dated May 30, 2024 from Stratus Roofing containing a list of 63 permits that were pulled for roof replacements for “Owner: Greenwood Condo Association” and work type “Re-Roof.” This document contained identifying permit numbers per address, and we separately located the permits themselves from the City of West Melbourne. However, the list of permits in the “Certificate of Completion” includes a substantial number of duplicate permits for the same work to the same building, and the roofing measurements stated on significant number of these permits does not align with the true roofing measurements for the buildings in question. Moreover, every single building had two permits pulled with identical roofing measurements to re-roof each building. Of the 63 permits pulled, 26 of those permits reflected that the Owner of the property in question was not Greenwood Condo Association. The subject policy provides as follows with respect to how covered losses are paid in CP 00 17 06 07 CONDOMINIUM ASSOCIATION COVERAGE FORM, which reads in part as follows: A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by the resulting Covered Causes of Loss. * * * G. Optional Coverages If shown as applicable in the Declarations, the following Optional Coverages apply separately to each item. * * * 3. Replacement Cost d. We will not pay on a replacement cost basis for any loss or damage: (1) Until the lost or damaged property is actually repaired or replaced; and (2) Unless the repairs or replacement are made as soon as reasonably possible after the loss or damage; e. We will not pay more for loss or damage on a replacement cost basis than the least of (1), (2) or (3), subject to f. below (1) The Limit of Insurance applicable to the lost or damaged property; (2) The cost to replace the lost or damaged property with other property: a. Of comparable material and quality; and b. Used for the same purpose; or (3) The amount actually spent that is necessary to repair or replace the lost or damaged property. If a building is rebuilt at a new premises, the cost described in e.(2) above is limited to the cost which would have been incurred if the building had been rebuilt at the original premises. f. The cost of repair or replacement does not include the increased cost attributable to enforcement of any ordinance or law regulating the construction, use or repair of any property. * * * Based upon this documentation, it still appears the insured has not actually spent more than American Coastal’s prior payments in completing the repairs to the property. Moreover, the documentation that was submitted does not include a list of transactions from the Insured to their roofing contractor that would clearly evidence the total amounts paid to date. The documentation that was submitted includes duplicative transaction receipts/proofs of payment. All documentation received to date does not reflect that the Insured has actually spent out of pocket expenses in excess of American Coastal’s payments on this claim. Moreover, the documentation that was submitted show significant inaccuracies provided to the City of West Melbourne’s Building Department regarding the roof replacements of the insured property’s roofs. For example, the Insured’s contractor submitted multiple permit applications and other documentation to the Building Department for the building located at 605-607 Greenwood Village Blvd. suggesting the total roof area was 196 SQs, but the total roof area for this building does not even exceed 100 SQs; according to the insured’s public adjuster’s estimate this building is only 81.60 SQ. Similar discrepancies in the documentation submitted to the City of West Melbourne’s Building Department are apparent for the other insured buildings as well. In light of the inconsistencies in the documentation provided, and the fact the documentation submitted does not reflect that you have actually spent more than the amounts paid by American Coastal, American Coastal sent correspondence dated November 14, 2024 advising that no further payments will be made on this matter and American Coastal will hereby close this claim. In light of American Coastal’s investigation, American Coastal has issued multiple, substantial claim net claim payments totaling $2,609,153.95 pursuant to the policy, not in breach of it and certainly not in bad faith. At no point has AmCoastal has received any documentation or information from the insured reflecting that the amount actually spent on the repairs to the property exceeded the amounts paid by AmCoastal. Accordingly, American Coastal Insurance Company denies any and all allegations of bad faith in connection with the claim submitted by Greenwood Village Condominium Association, Inc. If you have any questions, please do not hesitate to contact me. Sincerely, s/ Cristina P. Cambo Cristina P. Cambo, 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