Filing Number: 787536
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| Filing Accepted: 10/18/2024 |
| Last/Business Name
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THOMAS
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First Name |
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RONSHEKUA AND NATHANIEL |
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| Street Address
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542 BROCKHAM DRIVE |
| City, State Zip
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JACKSONVILLE,
FL
32221
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| Email Address
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RONSHEKUA2007@COMCAST.NET |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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THOMAS |
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First Name |
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RONSHEKUA AND NATHANIEL |
| Policy # * |
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AGH0312234 |
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Claim #* |
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CHO-00172442 |
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Attorney is Applicable
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| Last Name* |
TORRE
First Name *
GABRIEL
Initial
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| Street Address* |
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908 WEST HORATIO STREET |
| City, State Zip* |
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TAMPA
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FLORIDA
33606
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| Email Address * |
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GABE@MAKRISMULLINAX.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):*
JUSTIN HARDIN
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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 Delay
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Other
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Unfair Claims Settlement Practices
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Other
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Unreasonable Investigation
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Other
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Making material misrepresentations to the Insureds
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Other
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Failure to timely respond to communications in violation of F.S. § 627.70131(1)(a)
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Other
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Failure to timely render a claims determination in violation of F.S. § 627.70131(7)(a)
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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)(2) |
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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.
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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)(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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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 policy provisions include but are not limited to the perils insured against section of the policy and the loss payment provision of the policy as well as the provisions of the policy outlined in American Integrity Insurance Company of Florida’s (“American Integrity”) letter to the insureds dated April 22, 2024, including Coverage A dwelling, Coverage B other structures, and Section I regarding exclusions and limitations on coverage.
SECTION I – PERILS INSURED AGAINST
COVERAGE A – Dwelling and COVERAGE B – Other Structures
1. We insure for sudden and accidental direct loss to property described in COVERAGE A -
Dwelling and COVERAGE B -Other Structures only if that loss is a physical loss to covered
property. We do not insure, however, for loss:
b. Caused by:
(6) Any of the following:
(a) Wear and tear, “marring”, deterioration, scratching;
(b) Inherent vice, latent defect, defect or mechanical breakdown;
(f) Settling, shrinking, bulging or expansion, including resultant cracking, of
pavements, patios, foundations, walls, floors, roofs or ceilings;
2. Excluded under SECTION I – EXCLUSIONS.
At this time, these are the only provisions of the policy known to be in dispute, because these were the basis for American Integrity’s underpayment and partial denial of the insured’s claim.
The insureds nor their legal representatives are currently not in possession of a certified copy of the subject policy, as American Integrity has failed to provide despite multiple requests. If there are other portions of the policy that were not included in American Integrity’s coverage letter, which it believes limits or excludes coverage for the insureds’ loss, then the insured requests to be notified of that, and the insureds assert those provisions of the policy to also be applicable to 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.
• 626.9541(1)(i)(3)(i) -- Unfair claim settlement practices.
While the policy was in full force and effect, the subject property sustained a covered loss as a result of windstorm damage. Related damage was found to the exterior and interior of the property. American Integrity received timely notice of the loss and assigned claim number CHO-00172442, and adjuster Justin Hardin to investigate the claim.
Thereafter, American Integrity engaged in a results-oriented investigation that was designed to wrongfully underpay and partially deny the insureds’ claim. On April 22, 2024, American Integrity provided its coverage determination letter wherein it wrongly concluded that only ten (10) shingles were damaged by wind and that the thermal cracking and debonded shingles were the result of wear and tear despite the roof being only eight (8) years old. Lastly, American Integrity noted that the damage to the interior as well as some of the damage to the roof were pre-existing and addressed in a prior claim, Claim No.: CHO-00100088.
Ultimately, American Integrity performed a cursory inspection of the property failing to retain the professionals necessary to identify the damages and repairs necessary to restore the property to its pre-loss condition. This flawed investigation was conducted for the sole purpose of seeking a “results-oriented” opinion to partially deny and underpay the insureds’ claim.
It’s also important to note that American Integrity failed to actually issue payment for the insureds’ prior claim, Claim No.: CHO-00100088. Although American Integrity opened minimal coverage, which the insureds maintain was an underpayment, American Integrity failed to actually issue payment for such coverage. This failure to tender the undisputed payment precluded the insureds from performing any necessary repairs resulting from the prior claim. The lack of due diligence from American Integrity to follow up on the prior claim, and their failure to pay out damages they agreed to cover, effected prior reparations needed to restore property, and is now being used as a factor by American Integrity to partially deny and underpay insureds’ current claim Therefore, to the extent this failure to pay resulted in additional damage to the insureds’ property, such damage is the direct result of American Integrity’s bad faith conduct.
These actions forced the insureds to retain their own professionals to perform an inspection of the property, which identified damages that American Integrity knew existed but failed to address. During this inspection, wind damage to the roof of the subject property was identified. It was determined that a full roof replacement was necessary to return the property to its pre-loss condition. The cost of this replacement has been estimated at $36,175.97 by the insureds’ public adjuster.
Moreover, American Integrity’s continuous delay, and proper investigation of insureds claim has forced insured to hire other contractors to prevent further damage to the property. After receiving denial in April, insureds hired Fortress Roofing and Construction to perform emergency tarping services. This was estimated to cost $1,150.00. Not only is American Integrity’s basis for partial denial egregious, but their repair estimates for insureds property are greatly undervalued.
American Integrity’s failure to conduct a reasonable investigation and failure to pay the insured for the covered loss under the policy exhibits bad faith. American Integrity has failed to properly adjust this claim, failed to respond to communications, and has ultimately misrepresented the scope and cost of repairs required to return the property to its pre-loss condition. 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 insureds, American Integrity is delaying and unresponsive. Upon information and belief, American Integrity performs the subject actions as a business practice, including delaying the claim and underpaying the claim in an attempt to dissuade its insureds from further pursuing the claim to the detriment of its insureds to increase financial profits.
In the event American Integrity believes this civil remedy notice lacks information necessary for Universal to cure the defects outlined in this notice, or that it lacks required specifics in any way, American Integrity should contact the filer of this notice directly and alert them to that as soon as possible, prior to any formal response.
THIS NOTICE IS FILED AND GIVEN TO UNIVERSAL TO PERFECT THE RIGHT TO PURSUE THE CIVIL REMEDY THAT SECTION 624.155 AUTHORIZES. TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, UNIVERSAL MUST:
(1). ADMIT FULL COVERAGE FOR THE INSUREDS’ LOSS;
(2). PAY IN ACCORDANCE WITH THE ESTIMATE PREPARED BY THE INSUREDS’ PUBLIC ADJUSTER IN THE AMOUNT OF $$36,175.97
(3). PAY STATUTORY INTEREST ON THE AMOUNT OF UNPAID CONTRACT DAMAGES FROM THE DATE OF THE LOSS TO THE PRESENT TIME PURSUANT TO F.S. §627.70131.
A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN PROVIDED TO THE FOLLOWING PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE:
CLAIMSMAIL@AIICFL.COM
JUSTIN HARDIN
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
5426 BAY CENTER DRIVE, SUITE 600,
TAMPA, FLORIDA 33609
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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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