Filing Number: 785300
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| Filing Accepted: 10/2/2024 |
| Last/Business Name
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HANSELMAN
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First Name |
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DAVID AND CONSTANCE RENEE |
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| Street Address
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7415 OLD ST. AUGUSTINE RD |
| City, State Zip
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TALLAHASSEE,
FL
32311
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| Email Address
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HANSELMAN465@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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HANSELMAN |
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First Name |
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DAVID AND CONSTANCE RENEE |
| Policy # * |
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AGH0048699 |
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Claim #* |
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CHO-00173591 |
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Attorney is Applicable
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| Last Name* |
SUNDBERG
First Name *
WILLIAM
Initial
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| Street Address* |
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107 W FIFTH AVE |
| City, State Zip* |
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TALLAHASSEE
,
FLORIDA
32303
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| Email Address * |
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BILL@SUNDBERGPA.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 12841 |
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| Name of individual responsible for violation (if any):*
JEAN-LUC BENOIT
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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UNREASONABLE INVESTIGATION
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Other
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FAILURE TO ACT ON CLAIM
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
This Notice is based on Statutory Violations listed in this Notice.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
1) FAILURE TO PAY CLAIM IN FULL; 2) FAILURE TO PROMPTLY INVESTIGATE CLAIM; 3) FAILURE TO PROPERLY INVESTIGATE CLAIM; 4) FAILURE TO ADJUST LOSS; 5) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; 6) PLACING FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS AND CLAIMANTS; 7) FAILURE TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS; 8) LOOKING FOR WAYS TO DENY COVERAGE, PAY LESS, DELAY PAYMENT AND OTHERWISE “LOW BALL” OR “STONE WALL” CLAIM; 9) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS. THE INSURER APPEARS TO HAVE FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING.
THE INSURANCE COMPANY ISSUED A POLICY OF INSURANCE TO THE INSURED WHICH PROVIDED COVERAGE FOR CERTAIN LOSSES. DURING THE POLICY PERIOD ON OR ABOUT MAY 10, 2024, WIND CAUSED CONSIDERABLE DAMAGE TO THE INSURED PROPERTY. THE PROPERTY SUFFERED DAMAGE WHICH WAS AND IS COVERED BY THE INSURANCE POLICY. THE INSURED PROMPTLY REPORTED THE LOSS TO THE INSURANCE COMPANY AND COMPLIED WITH ALL CONDITIONS OF THE POLICY.
JEAN LUC BENOIT IS THE PERSON RESPONSIBLE FOR THE CLAIM AND THE INFORMATION REGARDING THE FACTS GIVING RISE TO THE ALLEGATIONS OF THIS CRN. MS. BENOIT WAS THE ADJUSTER WHO DELAYED THE INVESTIGATION AND FAILED TO PROPERLY ADJUST THE LOSS DESPITE HAVING ALL REQUIRED INFORMATION REGARDING THE DAMAGE FROM THE INSURED. THE CARRIERS REPRESENTATIVE INSPECTED THE PROPERTY AND PREPARED AN ESTIMATE. THE CARRIER DETERMINED THAT THEIR WAS COVERED DAMAGE TO THE PROPERTY, BUT SEVERELY UNDERESTIMATE THE COST BASED ON AN ESTIMATE OBTAINED BY THE INSURED. THE ESTIMATE PREPARED BY THE CARRIER ALSO GROSSLY UNDERESTIMATE THE AMOUNT AND SCOPE OF THE DAMAGES AS IS SHOWN BY THE INSUREDS ESTIMATE. THE CARRIER SENT PAYMENT PURSUANT TO THE UNDERVALUED ESTIMATE ON OR ABOUT JUNE 19, 2024. THE DEWELLING PAYMENT TOTALED $32,099.55 ACV AFTER THE DEDUCTIBLE WAS APPLIED. ESTIMATE DID NOT CONTAIN ALL OF THE COVERED WIND DAMAGES. IT IS CLEAR THAT THE INSURANCE COMPANY FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND DID NOT PUT THE INSURED IN THEIR PRE-LOSS CONDITION AS THE CLAIM WAS NOT ADEQUATELY PAID OR EVALUATE. THE INSURED PROVIDED A CONTENTS INVENTORY LIST OF $6,370.00. THE CARRIER DID PAY THIS AMOUNT.
AFTER THE LOSS OCCURRED, THE INSURANCE COMPANY PERFROMED A SUBSTANDARD INSPECTION AND DID NOT ADEQUATELY INSPECT ALL OF THE DAMAGES. THE INSURED RETAINED AN EXPERIENCED AND HIGHLY QUALIFIED CONTRACTOR, CYPRESS HILL SERVICES, TO ASSIST WITH THE CLAIM PROCESS AND PREPARE AN ESTIMATE OF DAMAGE. CYPRESS HILL ESTIMATED THE DAMAGE TO THE INSURED PROPERTY AT $156,244.93 RCV/ $142,103.13 ACV. THE INSURANCE COMPANY HAS STILL NOT FORMALLY RESPONDED TO THIS ESTIMATE DESPITE HAVING IT AND THE PROOF OF LOSS.
THE INSURED HAS PROVIDED THE INSURER WITH A SWORN STATEMENT IN PROOF OF LOSS, THE ESTIMATE OF AND THE AMOUNT OF DAMAGED PROPERTY. THE INSURED HAS MADE AN APPLICATION FOR INSURANCE BENEFITS UNDER THE POLICY BUT THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PAY THE FULL BENEFITS TO WHICH THE INSURED IS ENTITLED FOR THE LOSS. THE INSURANCE COMPANY HAS BREACHED THE POLICY OF INSURANCE BY FAILING TO PAY ALL OF THE BENEFITS DUE UNDER THE POLICY. THE INSURANCE COMPANY HAS FAILED TO SATISFACTORILY SETTLE THIS CLAIM AND HAS DEPRIVED THE INSURED OF A PROPER RESOLUTION OF THIS CLAIM. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PROPERLY INVESTIGATE THE LOSS AND HAS FAILED AND/OR REFUSED TO TENDER THE PROPER AMOUNT OF INSURANCE BENEFITS DUE AND OWING TO THE INSURED.
IN ORDER TO CURE THE CONDUCT GIVING RISE TO THE VIOLATIONS DESCRIBED HEREIN, THE INSURANCE COMPANY MUST COMPLETE THE PROPER EVALUATION OF THE DAMAGES VIA QUALIFIED PROFESSIONALS AND ISSUE PAYMENT FOR ALL THE COVERED DAMAGES. IN ADDITION, THE INSURANCE COMPANY MUST ISSUE PAYMENT TO THE INSURED FOR REASONABLE ATTORNEYS’ FEES, COSTS, AND PRE-JUDGMENT INTEREST IF REQUIRED BY THE APPLICABLE FLORIDA STATUTES. AS AN ALTERNATIVE CURE OPTION, THE INSURANCE COMPANY MAY CURE THE ALLEGATIONS GIVING RISE TO THIS NOTICE BY TENDERING A CHECK IN THE AMOUNT OF $142,103.13, LESS THE APPLICABLE DEDUCTIBLE AND/OR PRIOR PAYMENTS, WITHIN THE 60 DAY CURE PERIOD, JOINTLY PAYABLE TO THE INSURED AND SUNDBERG, P.A.
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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.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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