Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 787586

Filing Accepted: 10/18/2024

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Complainant

Last/Business Name *

ROHEL

First Name

CARTER AND LINDSEY

Street Address *

12241 AVILES CIRCLE

City, State Zip *

PALM BEACH GARDENS, FL 33418

Email Address *

CARTER.ROEHL@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		ROHEL		First Name		CARTER AND LINDSEY
Policy # *		FLP516291		Claim #*		1311866-241013

Attorney

Attorney is Applicable

Last Name*	MARTINEZ First Name * KELLI Initial A
Street Address*		3411 W. FLETCHER AVE, STE. B
City, State Zip*		TAMPA , FL 33618
Email Address *		PRESUIT@SULILAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		ASI PREFERRED INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 13142

Name of individual responsible for violation (if any):* ISELA LIGHTBOURN, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, ASI PREFERRED INSURANCE, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Not treating the Insured with good faith claims conduct
	Other : Looking for ways to deny full recovery to the Insured
	Other : Looking for ways to delay full recovery to the Insured
	Other : Failing to properly investigate the Insured’s loss
	Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made.
	Other : Not adjusting claims and evaluating loss properly
	Other : Shifting the burden of insuring the loss to the Insured
	Other : Failing to implement proper standards for the adjustment and investigation of claims

* 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)(d)		Denying claims without conducting reasonable investigations based upon available information.
	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.
	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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER FLP516291, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS FAILURE TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS. THE VIOLATIONS ALLEGED ARE ALSO STATUTORILY BASED AND DO NOT RELY ON ANY SPECIFIC POLICY LANGUAGE.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

ASI Preferred Insurance has committed the following in handling the insured’s claim: 1. Failing to act in due diligence and good faith to resolve claims 2. Placing the financial interest of the Carrier before that of the Insured 3. Looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims. 4. Not adjusting the claims promptly and fairly 5. Not attempting in good faith to settle claims 6. Conducting Inadequate investigations 7. Failing to employ policies and procedures to conduct adequate investigations 8. Failing to provide an estimate that complies with the Florida Building Codes. 9. Shifting the burden of investigating the loss onto the Insured. 10. Misrepresenting the terms of the insurance policy. 11. Failing to provide a loss run statement within 15 days. Carter Roehl and Lindsey Roehl are homeowners with an all-risks insurance policy issued by ASI Preferred Insurance Company (hereinafter “Carrier”). On or about, while the policy was in full force and effect, the Insured’s property, located at 12241 Aviles Circle Palm Beach Gardens, FL 33418, sustained significant damage as a result of a water loss. The insured promptly reported the claim and fully cooperated with the carrier’s investigation. The Carrier assigned claim number 1311866-241013 to the loss. After reporting the claim, Carrier retained an unqualified and biased field adjuster to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insured’s interest, the adjuster made a conscious effort to ignore evidence of covered losses to the property. Then in a letter dated March 13th, 2024, the carrier notified the Insured that it had completed its investigation into the loss and would be issuing payment for $368.49. Given the vastly underestimated cost of repairs, the Insured’s disagreement with the coverage decision, and the scope and nature of the damage resulting from the loss, the Insured through its retained representatives disputed the coverage determination and submitted an estimate prepared by Hunter Claims Public Adjuster for $35,120.49, Which was a fair and reasonable assessment of the loss. It was necessary for the insured to hire DryPro Inc. to perform emergency mitigation services in a effort to protect the property from further damages. DryPro performed reasonable and necessary services in the amount of $2,266.24 for EMS and $8,966.39 for mold remediation. Despite the obvious damage, the Insurer did not feel it was necessary to inspect the Insured’s home for mold. A mold inspection test can be purchased online from Amazon for around $46 before tax. This mold test only takes five minutes to assess whether or not the property has mold-particulates. However, the Insurer would much rather risk the health of the Insured in order to save some time and a money. In short, when it comes to mold, the Insurer accepts premiums but does not accept the responsibility of inspecting for mold. This is further evidence that the Insurer is placing its financial interest over the health and safety of the Insured. Worst still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition within reasonable time. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and bias adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition evidences Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and bias adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidences Carrier’s failure to conduct a reasonable investigation based upon available information. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer’s representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The conduct outlined above is done within the Insurer’s routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured’s interests or safety. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied full coverage for the claim. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer’s actions amount to but are not limited to the following: 1. Claim Delay: The Carrier has delayed processing the claim, causing frustration and inconvenience to the Insured. 2. Lack of Good Faith Conduct: The Carrier has not treated the Insured with good faith conduct expected when handling claims. 3. Attempt to Reduce Recovery: The Carrier has actively sought ways to minimize the amount owed to the Insured under the policy. 4. Attempt to Deny Recovery: The Carrier has looked for reasons to deny coverage altogether, rather than fulfill its obligations under the policy. 5. Failure to Property Evaluate Loss: Claims have not been assessed accurately or promptly, resulting in delays and incomplete indemnity for the Insured. 6. Inadequate Training and Supervision of Adjusters: The Carrier has not ensured its adjusters are adequately trained to handle claims promptly and fairly. 7. Placing Company Interests over Insured Interests: The Carrier has prioritized its financial interests over the health and safety of the Insured. 8. Failure to Provide Complaint Estimates: Estimates provided by the Carrier do not comply with Florida Building Codes. 9. Shifting Investigation Burden to Insured: The Carrier has unfairly placed the burden of investigating the claim onto the Insured. 10. Conducting Inadequate Investigations: The Carrier’s Investigation into the claim have been insufficient or cursory. Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: 1. Admit full coverage for the Insured’s loss and tender all additional amounts owed under the Policy for the covered loss to the insured property Please email any responses to this civil remedy notice to presuit@sulilaw.com A copy of this form submitted to the FDFS has been sent via email to the following parties, providing them notice of the filing of the civil remedy notice: • ASI Preferred Insurance via DFS Filing • Claims Department, ASI Preferred Insurance, via email; Claims@asicorp.org • Carter Roehl and Lindsey Roehl via email: carter.roehl@gmail.com

Comments

User Id		Date Added		Comment
darryl_j_roles@progressive.com		11-18-2024		While ASI Preferred Insurance Corp believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the notice in writing to Suli Law, on November 18, 2024.

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