Filing Number: 788220
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| Filing Accepted: 10/23/2024 |
| Last/Business Name
*
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| Street Address
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311 BERENGER WALK |
| City, State Zip
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ROYAL PALM BEACH,
FL
33414
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| Email Address
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ANNIBALMIOT@YAHOO.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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MIOT |
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First Name |
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PIERRE |
| Policy # * |
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AGH0375875 |
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Claim #* |
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CHO-00171646 |
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Attorney is Applicable
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| Last Name* |
DIX
First Name *
ERIN
Initial
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| Street Address* |
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350 NORTH LAKE DESTINY ROAD |
| City, State Zip* |
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MAITLAND
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FLORIDA
32751
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| Email Address * |
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EDIX@ITSABOUTJUSTICE.LAW |
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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):*
ANY ADJUSTER, MANAGER, OR INDIVIDUAL INVOLVED IN THE HANDLING OF THE SUBJECT CLAIM ON BEHALF OF THE INSURANCE CARRIER.
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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 Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(4) |
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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).
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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.
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
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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.
On or about April 26, 2023, the Insured, Pierre Miot, suffered damage to his home located at 311 Berenger Walk Royal Palm Beach, Florida 33414-4345 as a result of a severe windstorm event.
Prior to the loss, American Integrity Insurance Company of Florida (“American Integrity”), had issued a policy of insurance (Policy No.: AGH0375875) for the Insured’s property. Said policy was in full force and effect on date of loss and afforded coverage for windstorm damage.
American Integrity was timely notified of the loss by the Insured and assigned claim number CHO-00171646. During the course of American Integrity’s investigation, the Insureds made their 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 storm damage to covered property. The denial came, based on American Integrity’s engineering report but the engineer detailed contradictory conclusions: the staining on the ceiling of the second-story front-right bedroom was both damaged by normal aging and wear/tear (which would occur over time) but also by improper installation (which would have been an issue at the beginning of the property's life, not over time). The other areas where he detailed water intrusion, the staining on the second-story bathroom ceiling and the heavy staining to the ceiling and walls of the garage were all attributed to aging even though they occurred around the same time, within months after the storm occurred on April 26, 2023. The insurance company also did not provide the insureds with a copy of the engineering report.
American Integrity came to its coverage determination by ignoring relevant facts and information provided by the Insureds and their contractors that established the damages to the roof, interior, and exterior of the residence were unquestionably the result of wind. 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 Insureds. 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 Insureds’ 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 a windstorm event and immediately tender the full payment owed to the Insureds for damage to covered property in the amount of $75,434.66 less the applicable deductible. The written acknowledgement should be provided to the Insured’s counsel in writing at Erin Dix, Esq. at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
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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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