Civil Remedy Notice of Insurer Violations
Login

Filing Number:     786929
Filing Accepted:  10/15/2024
         Print Filing
Complainant
Last/Business Name *  
BUSTOS   First Name   CESAR D. AND MELANIE M.
Street Address * 4048 COONTIE CT
City, State Zip * LAKE WORTH, FL 33462
Email Address * PGPTAXES@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BUSTOS   First Name   CESAR D. AND MELANIE M.
Policy # * AGH0036104 Claim #* CHO-00172947
Attorney
Attorney is Applicable
Last Name* MCLESTER First Name * MINDY Initial
Street Address* 350 NORTH LAKE DESTINY ROAD
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * MMCLESTER@ITSABOUTJUSTICE.LAW
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):* ANY ADJUSTER, MANAGER, OR INDIVIDUAL INVOLVED IN THE HANDLING OF THE SUBJECT CLAIM ON BEHALF OF THE INSURANCE CARRIER.
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)(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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

A certified copy of the policy is not in the possession of the Insureds, but has been requested from the insurance carrier. Based on information and belief, the following policy provisions are relevant to this civil remedy notice.: Section 1 – Coverage A – Perils Insured Against Section 1- Conditions – Loss Settlement Section 1 – Conditions - Loss Payment
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about November 16, 2023, the Insureds, Cesar D. and Melanie M. Bustos, suffered significant damage to their home located at 4048 Coontie Ct., Lake Worth, FL 33462 as a result of a severe hailstorm. Prior to the loss, American Integrity Insurance Company of Florida (“American Integrity”), had issued a policy of insurance (Policy No.: AGH0036104) for the Insured’s property. Said policy was in full force and effect on date of loss and afforded coverage for wind and hail damage. American Integrity was notified of the loss by the Insured and assigned claim number CHO-00172947. During the course of American Integrity’s investigation, the Insured made the property available for inspection, provided facts and information surrounding the loss, and complied with American Integrity’s adjustment of the claim. Despite fully cooperating with American Integrity’s investigation, American Integrity capriciously denied coverage for the Insured’s insurance claim even though there was clear evidence of wind and hail damage to the roof. American Integrity came to its coverage determination by ignoring relevant facts and information provided by the Insured and his contractors that established the damages were unquestionably the result of wind and hail. Most concerning, American Integrity and its representatives either underplayed or misrepresented the findings from its own inspections in order to avoid having to tender payment on a claim that it knows should be covered pursuant to the terms of the policy. It is clear that American Integrity has not acted honestly or fairly towards its Insured. American Integrity and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope and cause of damages at the residence, and misapplied exclusions in the policy in order to deny coverage for the Insured’s claim. It has become a general business practice of American Integrity to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for American Integrity to arbitrarily deny claims without conducting reasonable investigations based upon information and evidence available to it. In order to cure this civil remedy notice, American Integrity must immediately acknowledge in writing that the roof, interior, and exterior damages claimed by the Insureds were caused by wind and hail and immediately tender the full payment owed to the Insureds for damage to covered property in the amount of $78,535.17 less the applicable deductible. The written acknowledgement should be provided to the Insured’s counsel in writing at Mindy McLester, Esq. at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
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 Mindy McLester, Esq. 350 North Lake Destiny Road Maitland, Florida 32751 MMcLester@ItsAboutJustice.law Re: DFS File No: 786929 Complainants: Cesar D and Melanie M Bustos Insureds: Cesar D and Melanie M Bustos Policy No: AGH0036104 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00172947 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Mindy McLester, 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 786929. 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, Cesar D and Melanie M Bustos. 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: Mindy McLester, Esq. via email at: MMcLester@ItsAboutJustice.law 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.

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.




DFS-10-363
Rev. 10/14/2008