Civil Remedy Notice of Insurer Violations
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Filing Number:     785042
Filing Accepted:  9/30/2024
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Complainant
Last/Business Name *  
VANTAGE POINTE POOL AND RACQUET CLUB CONDOMINIUM ASSOCIATION, INC.   First Name  
Street Address * 1429 N. ATLANTIC AVENUE
City, State Zip * DAYTONA BEACH, FL 32118
Email Address * VANTAGEPOINTE@BELLSOUTH.NET
Complainant Type: * Insured
Insured
Last/Business Name*   VANTAGE POINTE POOL AND RACQUET CLUB CONDOMINIUM ASSOCIATION, INC.   First Name  
Policy # * AMC-32808-06 Claim #* 4200384 (SDA FILE NO.)
Attorney
Attorney is Applicable
Last Name* MAMMEL First Name * CHRISTOPHER Initial N
Street Address* ONE NORTH CLEMATIS STREET, SUITE 510
City, State Zip* WEST PALM BEACH , FL 33401
Email Address * SMARKER@MERLINLAWGROUP.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):* OFFICERS, SUPERVISORS, AND OR MANAGEMENT OF AMERICAN COASTAL INSURANCE COMPANY; JOSEPH WHITTEN (ACCOUNT MANAGER, TPA SEDGWICK DELEGATED AUTHORITY); JEFF GOODE (FIELD ADJUSTER)
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Building coverage provisions; additional coverages; duties in event of loss policy provisions; all terms and conditions of Section I of the insurance policy; the insurance policy's definition section; the insurance policy's exclusion of coverage provisions; loss payment policy provision; loss settlement provision; the declarations page; we will adjust all losses with you.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. American Coastal Insurance Company (“American Coastal”), has breached this duty by its handling of the Insured, Vantage Pointe Pool and Racquet Club Condominium Association, Inc.’s Claim of Loss (Claim Number FLCON20000105; D.O.L. 09/28/2022). American Coastal has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. Shortly after September 28, 2022, the Insured submitted timely a claim to American Coastal for damages sustained as a result of Hurricane Ian. We have identified the following instances of bad faith conduct on the part of your company: • Purposefully minimizing the value of the claim by using biased estimating software/pricing and low-balling the cost of repairs. Specifically, estimations and repair costs have been purposefully devalued to the benefit of the insurance company despite knowledge that these costs are unreasonably deficient. This conduct reflects the intent of American Coastal to unreasonably depress the true cost of repairs and minimize payment of benefits owed under the policy. • Refusing to pay for necessary repairs and attempting to coerce the Insured into accepting a lower settlement amount by failing to properly consider all applicable statutes and building code requirements both at the state and local level. • Implementing a claim handling process geared solely to minimizing acknowledgement of storm caused damages. Specifically, ignoring clear evidence of cause and origin of interior damage through storm-caused openings in the exterior of the insured building, clear evidence of storm-caused moisture intrusion into the roofing material, and evidence of wind-pressure caused damages to fenestrations and resulting water intrusion, evidence of siding displacement, uplift, and detachment from wind forces, among other storm-caused covered damages. This scheme is meant solely to benefit the carrier while hindering the insured from obtaining just compensation for the loss. • Failure to adequately and timely prepare an estimate to include roof, fenestrations, interior and exterior damage caused by Hurricane Ian. More specifically, the American Coastal estimate dated on or about August 20, 2024 ($209,522.78 net ACV) omits substantial roof, fenestration, interior and exterior damage caused by windstorm during the policy period, although admittedly caused by the windstorm and admittedly covered, as compared to the estimate by Anderson Group International, general contractors, submitted in support of the Insured’s Sworn Statement in Proof of Loss estimating costs of repair as $4,648,310.24 (RCV) (incorporated herein by reference), prior to the deductible $787,364.85 and depreciation of $57,167.82. American Coastal has possession of these materials, which are incorporated herein by this reference. • Failing to reasonably investigate and subsequently acknowledge and reimburse costs of repairs to interior elements caused by water that intruded through storm-caused openings in the building envelope. • Failing to consent to appraisal of the amount of loss, in order to avoid the costs of litigation and utilize the alternative dispute resolution remedy created by American Coastal in its policy. • Admitting damages to the roofs, exterior and interior of the buildings, but estimating and making some partial payment for only roof damages after a reasonable opportunity to investigate fully and determine the amount of loss to all covered components admittedly damaged. This conduct was willful, unreasonable and in reckless disregard of the Insured’s rights under the policy. These actions on the part of your company are unacceptable and are in violation of the insurance policy, the duty of good faith and fair dealing that American Coastal owes to its policyholder, and fair claim handling practices reflected by statutes and industry standards accepted in Florida. Based on conduct to date, these practices occur with such frequency as to constitute a general claims handling process/business practice imbedded within the company’s management of Hurricane Ian claims. To date, notwithstanding the Insured’s pleas otherwise, American Coastal has continued to refuse to acknowledge its obligation to tender all insurance benefit monies due and owing the Insured or assist the Insured in mitigation of the damages. The insurer has failed and refused to acknowledge coverage and restore the Insureds to their pre-loss condition. American Coastal has sufficient information upon which to evaluate the Insured’s claim for damages, and certainly has been provided with an independent means by which to determine the amount of loss, but has failed to take reasonable steps to do so. The Insured has otherwise fully complied with the insurer's requests for post-loss compliance. American Coastal has not properly paid all of the covered damages. These actions by American Coastal occur with such frequency to indicate a general business practice of the company. The Insured has complied with the policy of insurance and Florida law, and American Coastal continues to wrongfully refuse to tender the insurance proceeds that are due and owing the Insured. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss. Florida statute section 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insured may be put back into the position it was in prior to the loss as quickly as possible. American Coastal breached this duty. The Insured was and still is forced to expend out of pocket monies to submit the insurance claim and encourage American Coastal to honor its obligations under the insurance policy to pay all the insurance proceeds due and owing it. American Coastal has clearly displayed bad faith in its handling, processing, and wrongful delay of this claim. The Insured merely requests that American Coastal "adjust the loss" with it in accordance with the policy of insurance for which American Coastal has accepted a premium, and in accordance with Florida law. American Coastal’s conduct has been reckless and unfair to its Insured and has caused and continues to cause additional damages. We demand that American Coastal immediately take steps to rectify the situation and handle this claim in a fair and appropriate manner. This includes providing full and fair compensation for the damages incurred and for any additional costs and expenses incurred as a result of American Coastal' bad faith conduct, including but not limited to, fees and costs related to the retention of personnel/counsel required to challenge American Coastal’ improper handling of this claim. [As of this moment, the damages found and evaluated by the Insured(s) value at minimum $4,648,310.24 (RCV) (incorporated herein by reference), prior to the deductible $787,364.85 and depreciation of $57,167.82 and we request payment in that sum as a curative measure to the conduct described herein, with allowance of “paid when incurred” amounts consistent with the policy.]
Comments
User Id Date Added Comment
kferry@camboferry.com 11-27-2024 November 27, 2024 VIA EMAIL ONLY Vantage Pointe Pool and Racquet Club Condominium Association, Inc. Merlin Law Group Attn: Christopher N. Mammel, Esq. 1 North Clematis Street, Suite 510 West Palm Beach, FL 33401 SMarker@merlinlawgroup.com RE: Date of Loss: 09/28/2024 Insured's name: Vantage Pointe Pool and Racquet Club Condominium Association Carrier Name: American Coastal Insurance Company Claim Number: 4200384 Policy Number: AMC-32808-06 CRN Filing Number: 785042 Dear Mr. Mammel, As you know, my firm represents American Coastal Insurance Company (“AmCoastal”) with respect to the above matter. This correspondence constitutes AmCoastal’s response to the Civil Remedy Notice of Insurer Violation (“CRN”) with filing number 785042 you filed on behalf of Vantage Pointe Pool and Racquet Club Condominium Association (“Vantage”). 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 AmCoastal on notice of the alleged violation. Additionally, a civil remedy notice must be “specific enough to provide Insurer 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. Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Also, it is invalid because it lacks sufficient specificity to provide notice to AmCoastal of the alleged wrongdoing, as discussed below. First, the Notice is invalid because it does not list a specific cure for the alleged violations and instead generally references full and fair compensation the damages including additional costs and expenses incurred. 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, no cure amount of any kind is provided, illusory statements are made as to full and fair compensation, additional costs and expenses related to bad faith, and the fees and costs related to the retention of counsel, and AmCoastal is left to guess what those amounts are and what would be required to “cure” the alleged violations. It is improper for a civil remedy notice to not contain a cure, therefore the CRN is invalid. 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). Second, the Notice is invalid because it conditions AmCoastal’s ability to “cure” by requiring AmCoastal 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 fees and costs and unknown additional “costs and expenses.” 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). Third, the boilerplate CRN lacks sufficient specificity to provide notice of the alleged bad-faith conduct. The CRN lists 12 different statutes/subsections which AmCoastal allegedly violated. However, the CRN fails to provide any relevant facts supporting the alleged violations or relating these alleged violations to the 12 cited statutes/subsections. Because the Civil Remedy Notice fails to identify any specific statutes or any facts to support why the Insured believes AmCoastal violated the statutes, AmCoastal is unable to properly respond, and the Notice is invalid and should be rejected and returned. Lastly, the CRN fails to sufficiently allege any specific policy provision which AmCoastal has violated. Instead, it generally outlines, “building coverage provisions. . . additional coverages. . . all terms and conditions of Section I of the insurance policy.” This is insufficient for AmCoastal to determine what portion of the policy the Insured is alleging has been violated and therefore the Notice 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., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Prop. & Cas. Ins. Co., 4D19-2763 (September 23, 2020); Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Again, in serving this response, AmCoastal 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. AmCoastal issued a commercial policy to the Insured, insuring the various properties located at 1429 N. Atlantic Ave, Daytona Beach, FL 32118, for a policy period from January 1, 2022 through January 1, 2023. The insured property is four give-story buildings and a garage/clubhouse for a total of five buildings that are insured as follows subject to a 5% Hurricane Deductible: The Insured’s public adjuster (“PA”), Jay Evans of Dietz International, reported a claim on November 8, 2022 for damage allegedly occurring a the subject property on September 28, 2022 as a result of Hurricane Ian. On November 29, 2022 Sedgwick Delegated Authority (“SDA”), on behalf of AmCoastal, acknowledged the claim, assigned a claim number, and provided the account manager/adjuster’s information. On or about January 17, 2023, Jeff Goode, Field Adjuster and Executive Building Consultant, John Brinkley from Sedgwick Building Consultants inspected the property on behalf of AmCoastal. Based upon the previous losses and claimed extent of damage being claimed, AmCoastal retained an engineer to inspect the subject property and to determine the cause and extent of the claimed damage. On January 31 and February 1,2023, Todd Martin, P.E, Charles Iselin, P.E. and Matthew Long, E.I.T inspected the Insured property. Based upon the information obtained during its inspections, AmCoastal confirmed damage to the roof, exterior, and interior of the buildings. On July 17, 2023, Zamal Dharka from Segwick Delegated Authority issued an initial coverage determination on behalf of AmCoastal which noted $833,370.01 damages to the Insured properties. After the application of the 5% deductible and depreciation, the net payment to the Insured was $8,189.63. Within this correspondence, AmCoastal advised that recoverable depreciation and/or the difference between the amounts paid and its initial ACV estimate would be considered once a certificate of completion from a contractor or detailed final invoice/cancelled checks have been received. No such information was ever provided. On January 18, 2023, July 27, 2023, May 28, 2024, and October 9, 2024, Sedgwick Delegated Authority issued a reservation of rights letters to the Insured that advised it was retaining Compass Building Services, a state licensed general and roofing contractor to re-inspect the property and provide real world bid for roof replacement and requested relevant material documentation, including: 1. Any engineering or expert reports which address the nature or cause of damage being claimed under American Coastal’s policy, and any photographs taken by the engineer or expert. 2. 2. Any and all Association Meeting Minutes, agendas, notes, records, logs for the last (10) years. 3. Any and all Association internal incident reports, maintenance records, vendor agreements, repair contracts, and repair records for the last (10) years. 4. Signed Proof of Loss (copy enclosed), including all estimates, proposals, invoices, invoices, receipts, permits and contracts, and correspondence for work performed or to be performed in related to the damage reported for this claim. 5. A copy of the Insured’s articles of incorporation, bylaws, declaration of condominium, and other documents creating any association(s), as well as all amendments to these items. 6. List of interior units with reported damage from this claim. 7. Any reports, including appraisals, prepared by or on behalf of the Association which speak to the condition of the property prior to the date of loss. 8. Any photographs, videos or otherwise which depict the condition of the property at any time, both before and after the date of the loss. 9. Any other documentation which supports the Association’s contention that the claimed damage was due to a covered cause of loss. Including contractor estimate, sign contract and permits etc. 10. Any documentation regarding mitigation services performed at the subject property. 11. Any documentation related to the flood damages, including but not limited to the flood policy, claim settlement letter and estimate etc. 12. Any and all documentation related to the roof history from 2012 to preset, including but not limited to maintenance records, bids, repairs, prior insurance claim documentation, estimate, settlement letter etc. 13. Itemized repair estimates with non-covered items, such as but not limited to flood and/or Unit Owner items, removed and sectioned off by location for appropriate application of deductibles. To date, the Insured has failed to reply to AmCoastal’s request for material information. The only documentation received to date in the two (2) years this claim has been investigated is a sworn proof of loss, estimate from Anderson Group International, Engineer Report from Anurag Jain, PhD, PE from Walker Consultants, and 5/7/24 estimate from Blue Star Roofing Inc. No further documentation was received. Plaintiff’s estimate includes line items for $16,582.11 in unspecified invoices for repairs related to this loss for which the Insured has failed to provide any support. On or about June 19, 2024, Compass Building Services, LLC prepared a bid estimate for the roof replacements at the Insured property totaling $855,519.20. Based upon the bid amount, AmCoastal submitted a supplemental coverage determination on August 20, 2024, wherein the estimate was adjusted to reflect the Compass bid and additional payment was issued in the amount of $209,522.78. This coverage determination noted that AmCoastal was still pending the information requested in its request for information to address other areas in dispute. This coverage determination was met with Insured retaining counsel, who filed this Civil Remedy Notice and Notice of Intent to litigate rather than being responsive to AmCoastal’s requests and complying with their duties under the policy. In response to this Civil Remedy Notice, counsel for AmCoastal continued requesting material information relevant to this claim from the Insured’s counsel and requested the parties engage in mediation. The parties agreed to mediation but to date there has been no documentation provided in response to the October 9, 2024 request. Mediation is currently scheduled to occur on December 20, 2024 and the parties are working towards amicably resolving this claim. No invoices or cancelled checks have been provided to support any work being performed by the Insured or that would necessitate the return of any recoverable depreciation. In addition, in the reservation of rights letter/request for information issued on October 9, 2024 by Sedgwick Delegated Authority, the Insured was advised that AmCoastal will not be extending the time limit on increased cost of construction based upon their failure to make the necessary repairs or provide any documentation outlining any incurred expenses, showing any repairs warranting an increased cost of construction, or showing any reasonable attempts to begin repairs as soon as possible to comply with the policies two (2) year time limit. Since the outset, Plaintiff’s representation has placed settlement ahead of a proper investigation of the loss. An insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. AmCoastal stands behind its coverage determination but will continue to work with the Insured to ensure an amicable resolution. As outlined above, AmCoastal has abided by the Policy and stands by its decision on this claim. As such, AmCoastal has complied with all policy provisions and applicable Florida law regarding the adjudication of this matter. Coverage was properly afforded for the Insured’s loss and payment was issued for covered damages in the amount of $217,712.41 for the subject claim, pursuant to the terms, conditions, exclusions, limits, recoverable depreciation, and deductible of the subject policy. Based on the foregoing, AmCoastal agrees that it will continue evaluating this claim and issue any payments for which coverage is confirmed but denies any and all allegations of bad faith in connection with the claim submitted by the Insured and considers this matter cured based upon the allegations within this CRN. If you have any questions, please do not hesitate to contact me. Warmest regards, CAMBO FERRY, PLLC Joshua D. Strudwick, Esq. jstrudwick@camboferry.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