Civil Remedy Notice of Insurer Violations
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Filing Number:     786842
Filing Accepted:  10/15/2024
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Complainant
Last/Business Name *  
PIERREVIL & PIERRE LOUIS   First Name   WILSON & NADIA
Street Address * 459 VINEYARD LANE
City, State Zip * ORANGE PARK, FL 32073
Email Address * WILSONPIERREVIL89@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PIERREVIL & PIERRE LOUIS   First Name   WILSON & NADIA
Policy # * AGH0484085 Claim #* CHO00175027
Attorney
Attorney is Applicable
Last Name* CAMPIONE First Name * FRANK Initial J
Street Address* 501 W. BAY STREET, SUITE 100
City, State Zip* JACKSONVILLE , FL 32202
Email Address * JASON@CAMPIONELAWPA.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
NAIC Company Code 12841
 
Name of individual responsible for violation (if any):* JUSTIN HARDIN AND ALL OTHER CLAIMS HANDLERS OR REPRESENTATIVES RESPONSIBLE FOR HANDLING THE CLAIM
Type of Insurance * Residential 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.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – PROPERTY COVERAGES AND SECTION I – PERILS INSURED AGAINST, INCLUDING BUT NOT LIMITED TO: COVERAGE A – DWELLING. ADDITIONAL COVERAGES INCLUDING BUT NOT LIMITED TO ORDINANCE OR LAW, AND ALL OTHER ADDITIONAL COVERAGES PROVIDED UNDER THE APPLICABLE POLICY. ALL OTHER APPLICABLE COVERAGE PROVISIONS, INCLUDING BUT NOT LIMITED TO ALL COVERAGE(S) PROVIDED BY ENDORSEMENT OR RIDER, THE DECLARATIONS PAGE, LOSS PAYMENT OR SETTLEMENT PROVISIONS, AND ALL OTHER PROVISIONS PROVIDING COVERAGE OF THE CLAIM AS PREVIOUSLY SUBMITTED TO THE INSURER. FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED 69B-220.201(3) – CODE OF ETHICS. THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. AN ADJUSTER SHALL PUT THE DUTY FOR FAIR AND HONEST TREATMENT OF THE CLAIMANT ABOVE THE ADJUSTER’S OWN INTERESTS IN EVERY INSTANCE. THE FOLLOWING ARE STANDARDS OF CONDUCT THAT DEFINE ETHICAL BEHAVIOR, AND SHALL CONSTITUTE A CODE OF ETHICS THAT SHALL BE BINDING ON ALL ADJUSTERS: 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 INSURED. 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.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

American Integrity Insurance Company, (“Insurer”) has committed the following in handling the Insured’s claim: 1. Failure to act in due diligence and good faith to resolve claims; 2. Placing financial interest of Insurer before that of the Policyholder and Claimant; 3. Not adjusting the claims promptly and fairly; 4. Not attempting in good faith to handle claims; 5. Looking for ways to deny full recovery to the Insured. On or about September 11th, 2023, Claimant suffered substantial damage to the exterior of the dwelling, due to wind damages, a covered peril under the policy. The policy provides insurance coverage for all the losses, damages, and expenses that Claimant suffered and incurred. The Insurer was provided with an estimate; however, the Insurer still failed to properly evaluate this claim and promptly settle although it has become reasonably clear that it should do so. The Insurer’s improper handling and delay in paying this claim has caused insurmountable damage to the Insured’s home that needs to be remedied immediately. Claimant gave the Insurer prompt and timely notice of Claimant’s claim once damage was discovered. The Insurer has not responded to the claimant’s demand. (1) Estimate for repair as well as other supporting documentation was provided to handling adjuster on August 28, 2024, (2) There are no Invoices for repairs or previous work or maintenance to the roofing to provide, and (3) No EMS documentation in claimant’s possession at this time. The Insurer’s actions amount to but are not limited to the following: 1. Not treating the policyholder with good faith claims conduct 2. Looking for ways to reduce recovery to the Insured 3. Not adjusting claims and evaluating loss properly, promptly, and fairly to provide full and prompt indemnity to the Insured 4. Not training, supervising, or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests 5. Placing the financial interest of the Insurer over that of the Insured. Florida law imposes no requirement to specify a definite cure amount to a civil remedy notice. Talet Enterprises v. Aetna Casualty & Surety Co., 753 So. 2d 1278 (2000). To cure the defects outlines in this civil remedy notice, the Insurer needs to pay the full amount necessary to bring the Insured’s home back to its pre-loss condition. The Insurer must also pay for any statutory costs and fees to which the Insured is entitled. This includes, but is not limited to, attorney's fees and costs, IF INCURRED, pursuant to Florida Statute 627.428, plus a 2.5 multiplier in accordance with the principles of Rowe v. Patient's Compensation Fund.
Comments
User Id Date Added Comment
swozniak@aii.com 10-24-2024 October 24, 2024 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, Florida 32399-0322 Frank J. Campione, Esq. 501 West Bay Street Suite 100 Jacksonville, Florida 32202 Jason@CampioneLawPA.com Re: DFS File No: 786842 Complainants: Nadia Pierre Louis and Wilson Pierrevil Insureds: Nadia Pierre Louis and Wilson Pierrevil Policy No: AGH0484085 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00175027 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Frank J. Campione, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on October 15, 2024 and assigned it DFS File No. of 786842. While American Integrity asserts that the subject CRN is legally insufficient and non-compliant with Florida law, American Integrity, without waiving any arguments regarding same, contends that it has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its Insureds, Nadia Pierre Louis and Wilson Pierrevil. The CRN contains a list of purported violations which are alleged to have been committed by American Integrity. In fact, none of the listed violations/allegations have occurred and/or are irrelevant to the alleged violations and American Integrity categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules contained in the CRN. In addition, American Integrity denies any and all allegations of any kind and/or any inferences therefrom referenced and/or contained in the CRN. American Integrity believes this response adequately addresses the allegations and violations contained within the CRN. Sincerely, Michael S. Sperounes Michael S. Sperounes, Esq. Senior Vice President of Litigation American Integrity Insurance Group cc: Frank J. Campione, Esq. via email at: Jason@CampioneLawPA.com CRN Response If this document contains an excerpt from an American Integrity Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the Insureds on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234
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