Civil Remedy Notice of Insurer Violations
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Filing Number:     786896
Filing Accepted:  10/15/2024
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Complainant
Last/Business Name *  
LOUISSAINT   First Name   DJELANN AND GREGORY
Street Address * 351 RED KITE DRIVE
City, State Zip * GROVELAND, FL 34736-80
Email Address * DJELANNL@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LOUISSAINT   First Name   DJELANN AND GREGORY
Policy # * AGH0253589 Claim #* CHO-00165597
Attorney
Attorney is Applicable
Last Name* LINE First Name * KACI Initial A
Street Address* 2431 LEE ROAD
City, State Zip* WINTER PARK , FL 32789
Email Address * KACI@TAGUSLAW.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):* RUBIN SANCHEZ AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA INVOLVED IN THIS 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.
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)(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.

The complainant will abbreviate the full policy language for purposes of brevity while clearly identifying the significant portions so the Respondent may identify the full language... THIS VIOLATION REFERENCES THE DEFINITIONS CONTAINED WITHIN THE POLICY AND ITS AMENDMENTS AND ENDORSEMENTS THAT PERTAIN TO COVERAGES FOR ROOF AND WATER DAMAGES (INDIVIDUALLY AND COLLECTIVELY) TO THE PROPERTY OF DJELANN AND GREGORY LOUISSAINT. THIS VIOLATION ALSO REFERENCES COVERAGES - COVERAGE A - DWELLING AND ALL APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE COVERAGE B - OTHER STRUCTURES PORTION OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES PERILS INSURED AGAINST COVERAGE A - DWELLING AND COVERAGE B OTHER STRUCTURES, ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE ORDINANCE AND LAW PORTION OF THE POLICY THAT WAS PURCHASED WITH PREMIUM DOLLARS PAID TO AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA. THIS VIOLATION ALSO REFERENCES SECTION I - CONDITIONS - SUBSECTION 3 LOSS SETTLEMENT AND ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES FUNGI, WET OR DRY ROT OR BACTERIAL COVERAGE ENDORSEMENT.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Section I Property Coverages provides coverage for the claim and there are no exclusions that apply. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA has failed to issue payment pursuant to the Loss Settlement Provision. During the coverage period while the policy was in full force and effect, the subject property sustained a sudden and accidental covered loss as a result of a hail and windstorm causing extensive damage to the property. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA (“AMERICAN INTEGRITY”) received timely notice of the claim and assigned claim CHO-00165597. AMERICAN INTEGRITY performed a cursory inspection of the property that failed to retain the experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. AMERICAN INTEGRITY continued the intentional path of claim delay and underpayment by failing to implement policies and procedures for payment of clearly covered claims. AMERICAN INTEGRITY time and time again, relies upon “cookie-cutter” reports that less than ironically state the cause of the damage to be identical to those exclusions found inside of AMERICAN INTEGRITY’s policy of insurance. AMERICAN INTEGRITY continues to fail to promptly settle the claim when its obligation to settle has, under all the circumstances, become reasonably clear. There is no question the roof of the Insured’s home was stuck by hail and winds so severe that caused damage and requiring a full roof replacement, and interior repairs. Despite this, AMERICAN INTEGRITY denied coverage for the clearly covered loss. AMERICAN INTEGRITY continues to rely upon more restrictive definitions of damage that is not contained within the policy and appears to only look for damage that would not be covered while intentionally not photographing or documenting the extensive covered damage. However, AMERICAN INTEGRITY continues to use more restrictive definitions of definitions of “hail” to deny a hail claim. Furthermore, AMERICAN INTEGRITY intentionally did not photograph multiple damaged area of the Insured’s property and did not use clearly damaged property areas while determining the covered loss. AMERICAN INTEGRITY relies upon the report and estimate of its adjuster which bears little to no relationship to the actual, visible damage to the roof and its necessary repair/replacement. It is clear that AMERICAN INTEGRITY has put its own interest over that of its insured and has made this case about protecting its bottom line as opposed to living up to the contract of insurance it was paid premium dollars for. The insurer’s conduct in this case occurs with such frequency as to constitute a general business practice. AMERICAN INTEGRITY knows it has failed to issue proper payment for the clearly covered loss to include damages and repairs covered by the policy and Florida law. Moreover, AMERICAN INTEGRITY has failed to comply with its loss settlement provision. Rather than issuing the proper payment or attempting to reach an agreement with its insured, AMERICAN INTEGRITY is delaying and denying the claim. Upon information and belief, AMERICAN INTEGRITY performs the subject actions as a business practice, including delaying and denying the claim and issuing "low ball" payments in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA can cure the violations contained herein by issuing a payment for all contractual damages owed, per estimates of $15,962.69 plus interest, costs, and attorney’s fees. This willful and wanton business practice in reckless disregard for the right of insurer’s insureds and is a violation of Florida Statute 624.155(1)(B)(1) which states it is an unfair claims settlement practice in “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 interest.” This willful and wanton business practice of insurer, in reckless disregard for the rights of its insureds, is in violation of Florida Statute 624.155(1)(B)(3), which defines unfair claims settlement practices to include “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.” This willful and wanton business practice of insurer, in reckless disregard for the rights of its insureds, is in violation of Florida Statute 626.9542(1)(I)(3)(a), which defines unfair claims settlement practices to include “failing to adopt and implement standards for the proper investigation of claims.”
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 Kaci A. Line, Esq. 2431 Lee Road Winter Park, Florida 32789 Kaci@TagusLaw.com Re: DFS File No: 786896 Complainants: Djelann and Gregory Louissaint Insureds: Djelann and Gregory Louissaint Policy No: AGH0253589 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00165597 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Kaci A. Line, 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 786896. 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, Djelann and Gregory Louissaint. 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: Kaci A. Line, Esq. via email at: Kaci@TagusLaw.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