Civil Remedy Notice of Insurer Violations
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Filing Number:     785507
Filing Accepted:  10/2/2024
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Complainant
Last/Business Name *  
OXFORD POINTE AT CROWN COLONY CONDO. ASSN., INC.   First Name  
Street Address * 8990 GREENWICH HILLS DRIVE
City, State Zip * FORT MYERS, FL 33908
Email Address * JERRYKATHYJONES@COMCAST.NET
Complainant Type: * Insured
Insured
Last/Business Name*   OXFORD POINTE AT CROWN COLONY CONDO. ASSN., INC.   First Name  
Policy # * AMC­36109­03 Claim #* 4198884
Attorney
Attorney is Applicable
Last Name* BERGER First Name * PAUL Initial
Street Address* 701 CHASE TREE STREET
City, State Zip* LAS VEGAS , NEVADA 89144
Email Address * PAUL@HURRICANELAWGROUP.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, AND ALL ADJUSTERS, CLAIMS REPRESENTATIVES, LOSS CONSULTANTS, ENGINEERS, ATTORNEYS AND EXPERTS, SHARON BLOW, ILAN CABALLERO FRANCO, MATTHEW CLEMENS, RICHARD RAGUCCI, MICHA
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
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.
* Specific policy language that is relevant to the violation.
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ACIC understands the risks with hurricane-exposed properties and stands ready to help you recover in the event of a catastrophe. Coverages A and B – including Loss Settlement and Loss Payment Provisions All Additional Coverages – Ordinance and Law Coverage Endorsements Declarations Duties in the Event of Loss Applicable Policy Definitions COVERAGES PROVIDED Insurance at the Described Premises Applies Only For Coverages For Which A Limit of Insurance is shown Described Location Premises Limit of Insurance Loc No. Bldg. No. Address Building 0001 0001 8990 Greenwich Hills Way $800,000 0002 0001 8986 Greenwich Hills Way $800,000 0003 0001 8980 Greenwich Hills Way $800,000 0004 0001 8976 Greenwich Hills Way $800,000 0005 0001 8970 Greenwich Hills Way $800,000 0006 0001 8966 Greenwich Hills Way $800,000 0007 0001 8960 Greenwich Hills Way $800,000 0008 0001 16101 Mount Abbey Way $800,000 0009 0001 16107 Mount Abbey Way $800,000 0010 0001 16113 Mount Abbey Way $800,000 0011 0001 16119 Mount Abbey Way $800,000 0012 0001 16125 Mount Abbey Way $800,000 0013 0001 16131 Mount Abbey Way $800,000 0014 0001 16137 Mount Abbey Way $800,000 0015 0001 16143 Mount Abbey Way $800,000 0016 0001 16149 Mount Abbey Way $800,000 0017 0001 16157 Mount Abbey Way $800,000 0018 0001 16160 Mount Abbey Way $800,000 0019 0001 16152 Mount Abbey Way $800,000 0020 0001 16146 Mount Abbey Way $800,000 0021 0001 16140 Mount Abbey Way $800,000 0022 0001 16295 Crown Arbor Way $800,000 0023 0001 8830 West Forest Lane $800,000 0024 0001 8824 West Forest Lane $800,000 0025 0001 8817 West Forest Lane $800,000 0026 0001 8825 West Forest Lane $800,000 0027 0001 8831 West Forest Lane $800,000 0028 0001 16311 West Forest Lane $800,000 0029 0001 16294 West Forest Lane $800,000 0030 0001 16298 Crown Arbor Way $800,000 0031 0001 16304 Crown Arbor Way $800,000 0032 0001 16308 Crown Arbor Way $800,000 0033 0001 16312 Crown Arbor Way $800,000 0034 0001 16316 Crown Arbor Way $800,000 0035 0001 16320 Crownsbury Way $800,000 0036 0001 16500 Crownsbury Way $800,000 0037 0001 16510 Crownsbury Way $800,000 0038 0001 16520 Crownsbury Way $800,000 0039 0001 16530 Crownsbury Way $800,000 0040 0001 16540 Crownsbury Way $800,000 0041 0001 16550 Crownsbury Way $800,000 0042 0001 16560 Crownsbury Way $800,000 0043 0001 16570 Crownsbury Way $800,000 0044 0001 16580 Crownsbury Way $800,000 0045 0001 16590 Crownsbury Way $800,000 0046 0001 16600 Crownsbury Way $800,000 0047 0001 16610 Crownsbury Way $800,000 0048 0001 16620 Crownsbury Way $800,000 0049 0001 16630 Crownsbury Way $800,000 0050 0001 16640 Crownsbury Way $800,000 AC N005 10 18 This form outline’s the insurer’s duties in responding to the notice: A response will be provided by us within 10 business days after receiving the notice. If responding to a notice served following a denial of coverage, we will respond by accepting coverage, continuing to deny coverage, or asserting the right to reinspect the damaged property. If we respond by asserting the right to reinspect, we have 14 business days after the response to reinspect and accept or continue to deny coverage. IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. WINDSTORM OR HAIL: COVERED CONDOMINIUM ASSOCIATION COVERAGE FORM All language CP 00 17 06 07 pages 1-14 A. Coverage 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. ORDINANCE OR LAW COVERAGE This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM STANDARD PROPERTY POLICY D. Coverage 1. Coverage A – Coverage For Loss To The Undamaged Portion Of The Building With respect to the building that has sustained covered direct physical damage, we will pay under Coverage A for the loss in value of the undamaged portion of the building as a consequence of enforcement of an ordinance or law that requires demolition of undamaged parts of the same building. 3. Coverage C – Increased Cost Of Construction Coverage a. With respect to the building that has sustained covered direct physical damage, we will pay the increased cost to: (1) Repair or reconstruct damaged portions of that building; and/or (2) Reconstruct or remodel undamaged portions of that building, whether or not demolition is required; when the increased cost is a consequence of enforcement of the minimum requirements of the ordinance or law. CONDOMINIUM ASSOCIATION COVERAGE FORM A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises in the Declarations caused by or resulting from any Covered Cause of Loss. 1. Covered Property Covered Property, as used in this Coverage Part, means the type of property described in this section, A.1., and limited in A.2., Property Not Covered, if a Limit of Insurance is shown in the Declarations for that type of property. a. Building, meaning the building or structure described in the Declarations, including: (1) Completed additions; (2) Fixtures, outside of individual units, including outdoor fixtures;
 
* Facts and circumstances giving rise to the violation.
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In Florida, the work of adjusting insurance claims engages the public trust. American Coastal Insurance Company (“American Coastal”) has breached this trust, the policy and Florida law by its handling of Oxford Pointe at Crown Colony Condo. Assn., Inc.’s (“Oxford Pointe”) Claim of Loss (Claim Number: 4198884; D.O.L. 09/28/2022). As described in detail below, American Coastal has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. American Coastal has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervising employees, resulting in statutory violations, as set forth above. American Coastal has hired teams of adjusters, engineers, consultants and attorneys to systematically engage in claim delays, underpayments and denials for their own financial benefit. On or about September 28, 2022, Hurricane Ian hit Fort Myers Florida as a Category 4 Hurricane. Ian caused over $112 billion in damage in the U.S. and was one of the most powerful tropical cyclones on record. Oxford Pointe was subjected to Category 4 winds for an extended period of time during Ian. Promptly after the storm (on or about October 4, 2022) the Insured submitted a claim to American Coastal for damages sustained as a result of Hurricane Ian. Despite the wind speed and strength of the hurricane at the Insured property, and widescale visible damages, American Coastal continues to breach the policy and Florida law by refusing to properly pay for covered losses to the roof, interior damages, windows and doors. In the nearly two years since Ian impacted Oxford Pointe, American Coastal has had teams of adjusters, engineers and building consultants inspect the property on numerous occasions. Despite repeatedly being provided with unfettered access to the property, American Coastal’s position is that the investigation is ongoing, which statement demonstrates the carrier’s complete disregard of Florida law, bad faith actions and breach of the policy. The facts clearly demonstrate that American Coastal was aware of all damages claimed, that it fully investigated this loss, and that American Coastal ignored damages and systematically delayed this claim for two years for its own financial benefit. We believe that American Coastal has intentionally misrepresented the facts of this claim in bad faith and with the sole purpose to underpay the claim. American Coastal’s actions were in violation of Fl Statute sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(h) and 627.70131. American Coastal was provided with prompt notice of the loss and sent an initial adjuster to “triage” the claim. Instead of acting in good faith and with proper speed and diligence to properly adjust the claim, it began a lengthy and systematic process of delay, denial and more delays. In accordance with the 2022 version of Fl Statutes 627.70131 “Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment.” American Coastal completely ignored this legal requirement and also violated Fl. Statute Sec. 624.155(1)(b)(3). Despite being made aware of this loss in a timely manner on October 4, 2022, American Coastal waited until December 12, 2022 to conduct a full investigation of the loss. The carrier’s team of adjusters and engineers (JS Held) inspected the property for several days (Dec 12-15). JS Held and adjusters from Sedwick were given unfettered access to the property and inspected roofs, interiors, doors and windows on all units at Oxford Pointe. This was acknowledged in writing by the carrier in a letter from Sharon Blow dated August 28, 2023, where she stated that “in addition to the roof damage to the property, J.S. Held was also provided access to all of the interior units at the property where it was claimed that water intrusion and water damage occurred as a result of Hurricane [Ian].” American Coastal refused to pay or deny the Insured’s hurricane claim for months as part of a strategy to systematically delay and underpay claims. On April 24, 2023 the Insured filed a 10 Day NOI and stated “American Coastal has had field adjusters and engineers inspect the insured properties, but has failed to issue a coverage decision and over 90 days have passed and there are no circumstances beyond the control of American Coastal. As a result, American Coastal is in breach of the policy of insurance.” American Coastal’s actions were in violation of Fl Statute sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131. Finally on August 28, 2023, eleven months after Hurricane Ian, American Coastal issued its Coverage Determination Letter. This letter along with an estimate and engineering report from American Coastal documents that (1) American Coastal was aware of the claim for damages including the roofs, exterior, windows and doors and interior damages; (2) American Coastal was provided with unfettered access to the property; (3) the Insured was in complete compliance with the policy and (4) American Coastal clearly violated Fl Statutes sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131 and the policy. This letter from Ms. Blow and the actions of the adjusters handling this claim, demonstrate that they have violated the Adjuster Code of Ethics, the Florida Administrative Code Sections: 69B-220.201(3)(b) An adjuster shall treat all claims equally. An adjuster shall not provide favored treatment to any claimant. Adjuster shall adjust all claims strictly in accordance with the insurance contract. 69B-220.201(3)(b)2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. 69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insureds. 69B-220.201(3)(d) – An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. 69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. The JS Held engineer report that the coverage determination letter was based upon is dated February 9, 2023. American Coastal had this report for over six months before it is issued its coverage determination. Essentially American Coastal shelved the report to delay the claim for months. This is a clear violation of the policy and Fl Statutes sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131. Moreover, the estimate and engineering report ignored significant damages. After inspecting interior units for damage to doors and windows, American Coastal determined that only one window was damaged, despite the windows being subjected to 130+ MPH winds for 12 hours. According to NOAA during storms the strength of Ian “Well-built framed homes can sustain severe damage with loss of most of the roof structure and/or some exterior walls.” Significant damage would be expected to the windows, but this damage was either not inspected or ignored to underpay the claim for the financial benefit of American Coastal. Despite inspecting all roofs at the property, American Coastal paid for minor tile repairs on most roofs. This repair includes the roof tile, roofing nails, and installation labor. This repair completely ignores damage to the underlayment which is the primary water resistant material of the roof. American Coastal ignored all damages to the underlayment for their own financial benefit. American Coastal’s actions were in violation of Fl Statute sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(h) and 627.70131. The carrier continued its delay tactics and requested additional window inspections. American Coastal retained Miami Curtain Wall to inspect the doors and windows. The inspections occurred on November 13 and 14, 2023. Miami Curtain Wall established what units they wanted to inspect and again was given unfettered access to the property. Despite inspecting windows, doors and interiors in 2023, the carrier did not take any position on the door and window claim and ignored it in its entirety in violation of the policy and Fl Statutes sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131. Miami Curtain Wall is not a licensed engineering firm or adjusting firm. They are merely a group of unlicensed and unqualified consultants. The consulting team was led by Michael Lamborghini, who is not a licensed adjuster or engineer. Conducting a cause and origin inspection of the windows and doors for hurricane damage requires an engineering license in the State of Florida and both Mr. Lamborghini and Miami Curtain Wall are unlicensed in violation of State Law. American Coastal is using unlicensed consultants in violation of Florida law for the purpose of delaying, underpaying and denying claims in violation of Fl Statutes sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131. In March 2024 the Insured provided the Carrier with a Proof of Loss and detailed estimates totaling more than Twenty-Two million dollars. Included with this documentation was a window and door replacement estimate and roof replacement estimate. Again the carrier did nothing for months and ignored materials provided by the Insured. In fact, no further request for additional inspections of the doors and windows was requested until July 2024. Despite the failure of American Coastal to complete its investigation of the doors and windows claim as required under FSA 627.70131. American Coastal’s lack of response to the Proof of Loss and documentation was a violation of the policy and Fl Statutes sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131. Oxford Pointe allowed more inspections by Miami Curtain wall in August 2024 for an entire week. Miami Curtain Wall again was provided with unfettered access to inspect doors and windows. On September 18, 2024, the carrier again asked for additional inspections to complete inspection of the unit interiors, windows, and doors. American Coastal has spent weeks at this property with different teams of engineers, consultants and adjusters and was provided unfettered access to the property. It refuses to compete its inspections and tender all amounts owed under the policy in violation of the policy and Fl Statutes sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131. Not being satisfied with this treatment and the poor attempt at claims handling, delays, deception and non-explanations by the insurer, the Insured moved forward to have an independent, competent opinion as to causation and scope of their losses at great financial cost to the Insured. The Insured retained APEC engineering led by Matt Phelps, a highly respected and renown engineer, to inspect the insured properties with special focus on roofs, doors and windows. Mr. Phelps and APEC spent significant time inspecting the buildings and conducted both roof and window testing, and determined that the roofs, windows and doors at the property sustained significant windstorm damage during Ian and need to be replaced. The APEC Engineering report was provided to American Coastal and was ignored in its entirety. This report which evidenced storm damage should not be summarily dismissed by the Insurers but rather should be given the credence and acceptance which is rightfully merited. The carrier’s refusal to consider evidence of significant storm damage is further proof of its bad faith claims handling. An insurer is obligated to make coverage determinations based upon reasonable explanations and reasonable investigations. A fair and reasonable investigation would have found that the full damage to the property, as documented by APEC Engineering, necessitated roof, window and door replacement. These damages are covered losses and a reasonable investigation would have provided full coverage and prompt payment to the Insured in the amount in the Proof of Loss. In refusing to following APEC Engineering report and tender all amounts owed under the policy in violation of the policy and Fl Statutes sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(a) and 627.70131. In addition to the above items, we have identified the following instances of bad faith conduct on the part of American Coastal: • Purposefully minimizing the value of the claim by using biased consultants and adjusters to minimize damages. • Refusing to pay for necessary repairs, ignoring damages and failing to properly consider all applicable statutes and building code requirements both at the state and local level. • Implementing a claim handling process geared to minimize storm related damages, especially roof and window damages. This scheme is meant solely to benefit the carrier while hindering the insured from obtaining just compensation for the loss. • Purposefully and deliberately failing to account for all wind damage to the roofs, windows, doors, and interior of the subject properties. • Misrepresenting that roof repairs where only tiles are replaced are proper repairs, rather than a roof replacement is needed for roofs of the subject property. • Failing to adopt and implement standards for the proper investigation of the claim; failing to conduct a proper investigation of any and all wind damage to the properties, including but not limited to, all wind damage to all of the roofs and windows. • Failing to perform an adequate roof investigation to assess damage to underlayment. • Failing to perform inspection and testing on windows by qualified engineers to assess window damages. These actions are in violation of the insurance policy and the duty of good faith and fair dealing that American Coastal owes to its policyholders. 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, American Coastal has continued to refuse to acknowledge its obligation to tender all insurance proceed 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 Insured 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. 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 Statutes 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. American Coastal must immediately take steps to rectify the situation and oversee 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's bad faith conduct, including but not limited to, fees and costs related to the retention of counsel required to challenge American Coastal’s improper handling of this claim. As of this moment, the damages found and evaluated by the insured(s) value at minimum $25,000,000, including damages, fees and interest and we request payment in that sum as a curative measure to the conduct described herein. SUMMARY OF STATUTORY VIOLATIONS: The statutory violations here are many and varied and have occurred simultaneously and concurrently, generally serve as an unfortunate model for insurer unfair claims practices, and they include but are not limited to the following: This intentional, willful, wanton, and wrongful conduct referenced above is a clear violation of multiple Florida Statutes, including but not limited to 624.155(1)(b)(1), 626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(i), and shows that this carrier did not attempt in good faith to settle the Insureds claim(s) when, under all the circumstances, it could have and should have done so, had it acted fairly and honestly toward its Insured and with due regard for the Insureds interests. The insurer is obligated to engage in fair claims practices and make timely coverage determinations based upon reasonable explanations and reasonable investigations. This did not happen. A reasonable investigation would have found that the damage to the insured property was fully covered, and the result of a reasonable investigation would have been to provide coverage and prompt, full payment, which has not been done. American Coastal’s actions were in violation of Fl Statute sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(h) and 627.70131. The totality of the actions, inactions, obfuscations, and insurer misconduct as set forth above constitutes unfair claims practices. THEREFORE: This insurance carrier, AMERICAN COASTAL, must: (1) create and implement adequate guidelines for the proper investigation and evaluation of these types of claims and for the training and supervision of employees, which will avoid future statutory violations. (2) create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees in connection with legitimate claims to ensure that the claims handling procedures are adequate to prevent other insureds from being treated unfairly and wrongfully; and (3) immediately tender all available insurance proceeds, plus interest and costs to the Insured, presently known to be at least $25,000,000, while continuing to adjust the loss with the Insured, including but not limited to honoring their reciprocal duties and agreement to abide by all Policy terms; and (4) tender to the Insured all amounts representing monies paid for remedial or temporary repairs and less any prior payments, applicable depreciation, and deductibles; and (5) pay interest on untimely payments from the date the carrier was notified of the loss or, upon the election of the Insured, pay such other interest payments as may be available under Florida law, including prejudgment interest; and (6) pay attorney’s fees and costs; and (7) exercise good faith efforts to resolve these claim(s) by acting fairly and honestly towards the Insured and with due regard for the Insureds interests in disclosing all evidence which supports their position, and in attempting to fully settle the entirety of its Insureds claim(s).
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michael@zinoberdiana.com 11-29-2024 November 29, 2024 Via DFS E-Filing Portal Department of Financial Services Division of Consumer Services 200 East Gaines Street Tallahassee, FL 32399 Re: Insured: Oxford Pointe at Crown Colony Condominum Association, Inc. CRN Filing No.: 785507 Filing Date: October 2, 2024 Insurer: American Coastal Insurance Company Claim No.: 4198884 Policy No.: AMC-36109-03 Dear Sir or Madam: Please accept this as American Coastal Insurance Company’s (“American Coastal”) response to the Civil Remedy Notice of Insurer Violation (“CRN”) bearing filing number 785507, which was filed on October 2, 2024 by American Coastal’s insured, Oxford Pointe at Crown Colony Condominium Association, Inc. (“Oxford Pointe”). American Coastal has had an opportunity to review the CRN filed by Oxford Pointe and hereby denies each and every allegation of statutory violation and/or bad faith conduct. American Coastal has, at all times, handled Oxford Pointe’s underlying insurance claim for Hurricane Ian damage in utmost good faith. At the outset, it should be noted that the CRN is deficient on its face. The CRN contains a “cure” demand that includes amounts of money that cannot be a contractual amount due and owing, but rather include alleged damages that would require American Coastal to pay amounts indisputably not owed to Oxford Pointe as of the date the CRN was filed. For instance, the CRN demanded on October 2, 2024 that American Coastal pay “attorney’s fees and costs” to Oxford Pointe. Under no statute nor any contract did American Coastal, or could American Coastal, have owed Oxford Pointe attorney’s fees and costs. As such, the cure demand seeks damages and amounts that would only be recoverable in a bad faith action, which are exactly the type of damages a CRN is meant to provide an insurance carrier with the opportunity to avoid. To demand, as a cure, amounts that would only be recoverable in a bad faith action, Oxford Pointe has deprived American Coastal of the right to cure any alleged bad faith conduct/statutory violations. As such, the CRN is completely deficient on its face, should be rejected, and cannot form the foundation for a lawsuit for damages pursuant to Fla. Stat. § 624.155. Additionally, as you can see from the CRN, Oxford Pointe takes the position—with which American Coastal disagrees—that Oxford Pointe has been fully transparent and straightforward at all times regarding its claim. Yet, in the CRN, Oxford Pointe makes a demand (in addition to the aforementioned attorneys’ fees and costs, as well as alleged remedial and temporary repair costs) of “at least $25,000,000.00.” This is despite Oxford Pointe previously having provided American Coastal with a Sworn Statement in Proof of Loss stating, under oath, that the Whole Loss and Damage to the subject property was $22,359,798.70. Meaning, despite swearing under oath that the full value of the damage to the property was just over $22,000,000, Oxford Pointe has demanded “at least” $25,000,000, plus attorneys’ fees, costs, interest, and costs for temporary and remedial repairs. For this reason, it is patently clear that the “cure demand” contains costs and items that are beyond the “contractual amount due” even as claimed by Oxford Pointe, and therefore is an improper cure demand that renders the CRN deficient on its face. As for the facts underlying the claim, American Coastal denies and rejects the allegations made by Oxford Pointe. First, contrary to the allegations of the CRN, the property was initially inspected by American Coastal’s adjuster on October 18, 2022, i.e., within three weeks of the date of loss. Oxford Pointe’s attorney reported to American Coastal in November of 2022 that only 20 of the 200 units at the property had interior damage from the storm. There was no mention of damage to all of the exterior windows and doors for each of the 50 buildings at the property. Subsequent to the field adjuster’s inspection, American Coastal then coordinated with Oxford Pointe to have the property inspected by an engineering firm, J.S. Held, which inspections took place on December 12, 13, 14, and 15 of 2022. As a result of this inspection of the property, J.S. Held prepared reports and estimates for repairs to the property. American Coastal’s consultants also photographed the interiors of the units allegedly affected by Hurricane Ian. In January of 2023, American Coastal issued an advance payment to Oxford Pointe of $350,000. It should be noted that the subject insurance policy contains a 5% hurricane deductible, with each building having been insured up to a limit of insurance of $800,000. Meaning, each building has an applicable hurricane deductible of $40,000.00. Accordingly, the $350,000 advance payment was in addition to the applicable hurricane deductible. Based on the inspections of American Coastal’s consultants, J.S. Held prepared a report and a repair estimate. The repair estimate allowed for repairs to the interiors of the units affected by Hurricane Ian and allowed for a harvest and repair method of repair to the roofs of the property. J.S. Held’s estimate allowed for the complete removal and replacement of 2 of the roofs at the property, and then allowed for the utilization of the tiles harvested from those two roofs to make repairs to the remaining damaged roofs. It should be noted that American Coastal also considered a straightforward repair protocol for the roofs (without the harvest and repair method), which ended up with a lower repair cost estimate. In furtherance of providing Oxford Pointe with the most coverage available under the policy, American Coastal afforded coverage for the more expensive harvest and repair method of repair. The amount of net coverage, after application of the deductible, was less than the $350,000 advance payment made by American Coastal. American Coastal did not ask for any of the advance payment to be returned, despite there having been an overpayment. On October 31, 2023, the examination under oath of Oxford Pointe’s president and appointed representative, Jerry Jones, took place. During that testimony, he advised that no windows had been repaired at the property by Oxford Pointe because of the storm. He further advised that he could not state whether there were any ongoing window leaks at the property since the passage of Hurricane Ian. He testified that “Apec Engineering” inspected the roofs within the month preceding his examination under oath. As of October 31, 2023, Mr. Jones testified that no one had told him that the windows and doors at the property had to be replaced, and he further advised that it was his understanding that a window and door evaluation was still in the process of being performed. He also could not confirm whether a claim for the windows and doors was being made, and expressly stated that “I think we will have to wait on the engineering report.” It was not until July 25, 2024 that Oxford Pointe provided American Coastal with any documentation to set forth or demonstrate any alleged damage to the windows and doors of the property as a whole. As a result, at the end of August of 2024, an inspection was coordinated whereby American Coastal’s retained consultants, Miami Curtain Wall Consultants, Corp. (“MCWC”) and Compass Building Services (“Compass”) were supposed to be provided access to the interiors and exteriors of each and every unit at the property so that the interiors and windows and doors of each unit could be inspected. While the inspections went forward, full access was not granted to MCWC or Compass. American Coastal has followed up a number of times to have Oxford Pointe provide the requested access, and those requests have either been denied or ignored. In the CRN, Oxford Pointe takes aim at the credentials and qualifications of MCWC. A cursory review of the credentials of MCWC renders these allegations and attacks frivolous on their face. MCWC is a company comprised of architects and/or engineers who have vast experience in the design, pre-occupancy and post-occupancy inspections, installation, technical specifications, threshold inspections, window and door laboratory, water infiltration, and air filtration testing, and forensic evaluations of window and door systems on some of the most complex and substantial building projects in Florida. Oxford Pointe’s attorneys attempted to obstruct the ability of MCWC to fully evaluate the window and doors at the property, and to date have not provided information to American Coastal or its consultants regarding window systems that were purportedly tested for water infiltration by Oxford Pointe’s own consultants. Despite all of the foregoing, in an effort to ensure that the correct amount of coverage was afforded to Oxford Pointe, American Coastal had Compass prepare a supplemental repair estimate of all damage to the subject property that was determined to have been caused by Hurricane Ian. On November 27, 2024, American Coastal sent a supplemental coverage determination letter to Oxford Pointe to advise them that the Compass repair estimate determined that the cost of repair to Hurricane Ian related damage to the subject property, after application of the applicable deductible, was less than the amount of the January 2023 $350,000 advance payment. This was consistent with the original assessment reached by J.S. Held. As such, no further coverage was due and owing. To summarize, American Coastal has continued to adjust the claim with Oxford Pointe. This is despite the fact that Oxford Pointe has taken substantial amounts of time to provide information related to their ever-evolving claim for damages and has even failed to cooperate with American Coastal’s reasonable requests for information and access. American Coastal denies the allegations of bad faith conduct or statutory violations. The CRN fails to satisfy the specificity requirements of Fla. Stat. 624.155, as it contains conclusory allegations and assertions without any real factual support. American Coastal has not delayed the adjustment of the claim, has not failed to attempt to settle the claim, has not made claim payments failing to set forth the coverage under which the payments are made, has not made any misrepresentations, material or otherwise, has not failed to acknowledge or respond to correspondence, has not failed to adopt standards for the proper investigation of claims, and has not wrongfully denied any portion of a covered claim. American Coastal has provided Oxford Pointe with the engineering report it has obtained, as well as to the two separate repair estimates upon which it based its evaluation of coverage. American Coastal has handled Oxford Pointe’s claim in utmost good faith and has attempted to determine the full value of covered damage to the Oxford Pointe community. All allegations of bad faith conduct or statutory violations contained within the CRN are hereby denied, whether express or implied. If there are any allegations that have not been expressly or directly addressed by this response, any such allegations are hereby denied in their entirety. American Coastal does not, by this letter or otherwise, intend to waive any rights that it may have under the subject insurance policy or applicable law. American Coastal expressly reserves all rights. If anyone at the department has any further questions regarding the foregoing, please do not hesitate to contact the undersigned. Best personal regards. ZINOBER DIANA & MONTEVERDE, P.A. ________________________________________ Michael A. Monteverde, Esq. Cc: Oxford Pointe c/o Steve Simon, 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