Civil Remedy Notice of Insurer Violations
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Filing Number:     788266
Filing Accepted:  10/23/2024
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Complainant
Last/Business Name *  
AGUSTIN   First Name   JORGE
Street Address * 3100 BROWARD AVE
City, State Zip * GREENACRES, FL 33463
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   AGUSTIN   First Name   JORGE
Policy # * 2MR154069000 Claim #* 00201794831
Attorney
Attorney is Applicable
Last Name* PARDO First Name * ERIKA Initial
Street Address* 618 E SOUTH STREET, SUITE 500
City, State Zip* ORLANDO , FL 32801
Email Address * ERIKA@THEPARDOLAWFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN SECURITY INSURANCE COMPANY
NAIC Company Code 42978
 
Name of individual responsible for violation (if any):* MELAKU ABEBE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Governed by the cited authorities, the subject policy provides coverage for sudden and accidental losses and damages arising from a sudden and accidental plumbing system failure. The loss payment provision and governing law provides that the insurer has a fiduciary duty to in good faith to promptly investigate, adjust, and issue payment of the undisputed amount of the loss and damages. Furthermore, the policy provides coverage for, inter alia, assessments in relation to remediation, as well as the amount necessary to perform remediation. The operative relevant Policy of Insurance at issue is an “all risk” Policy which provides as follows: SECTION I-PERILS INSURED AGAINST A. Coverage A-Dwelling and Coverage B- Other Structures
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

American Security Insurance Company ("ASIC") issued a policy of insurance (“Policy”) insuring the Complainant, Jorge Agustin's real property and which provides coverage for sudden and accidental damages and losses arising from Hurricane Ian (“Loss”). The Loss caused substantial, direct and consequential damages, and ASIC's general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment for the claims, has caused the Complainant to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. The stated misconduct outlined below is collectively referred to as “Bad Faith,” and the specific, straightforward factual and/or legal considerations in relation thereto are further outlined below for its consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith. On or about September 28, 2022, Hurricane Ian struck the property. Damages manifested later in time and the Complainant suffered direct physical loss to the subject property due to Hurricane Ian. The Complainant hired Full Pro Restoration Inc. to perform the necessary, industry wide practice of performing moisture meter assessments coupled with the corresponding thermal imaging, to detect latent conditions, which, if undetected, will serve to create toxic conditions at the subject property. During the adjustment of the claim, all relevant documents from Full Pro. Restoration Inc., were dutifully provided. To date, no adjuster and/or qualified expert has been retained by ASIC to dispute findings of elevated latent levels of water moisture at the subject property via the moisture meter assessments coupled with the corresponding thermal imaging. To date, no adjuster and/or qualified expert has been retained by ASIC to dispute the necessity and/or reasonable course of repairs by way of the remediation services provided. ASIC inspected the subject property by way of a field adjuster by the name of Reynaldo Munoz (hereinafter referred to as “Mr. Munoz”). It is believed that Mr. Munoz is not and has not been disclosed as a qualified expert to attest as to the cause and/or full extent of the damages at the subject property. In addition, as of the date of this filing, Mr. Munoz has failed to dispute the latent water damages that were detected via the moisture meter assessments and/or corresponding thermal imaging, as well as the necessary water remediation services provided, coupled with the mold testing if any, and any corresponding mold remediation to protect the inhabitants of the subject property from toxic conditions. Based on the insufficient adjustment of the claim as outlined herein, ASIC on or about July 10, 2024, issued a wholly unsatisfactory valuations of $7,069.58 (replacement cost value) and $5,675.96 (actual cash value). In opposition to same, the Complainant (through his retained counsel) has obtained a repair or damage estimate with a valuation of $83,994.49 (replacement cost value and $81,118.88 (actual cash value, that duly takes into consideration the full extent of the latent conditions, that serve to create a plethora of extra contractual damages that continue to accrue, given ASIC’s general business practice of failing to adjust the full extent of the damages as outlined herein. In other words, the Complainant hereby notifies ASIC of its unsatisfactory, lowball valuation of the underlying claim. To cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of bad faith claims handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the insured’s interests being implemented, ASI must perform as follows within 60 days of receiving this CRN: I. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same, and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant as per the industry wide accepted standards outlined herein; II. Take corrective action and draw a swift resolution as to the disputed amount of the loss to resolve this claim. To hold otherwise, would allow ASIC’s bad faith claims handling described above to leave the insureds, the insured’s counsel, the insurer’s counsel, and even the judiciary guessing as to when and how ASIC will duly perform. These continuously vacillating positions and cherry-picking of the described bad faith conduct outlined herein, not only serves to maximize ASIC’s prospective financial gains by being able to avoid paying benefits, it also serves to minimize ASIC’s loss adjusting expenses as it sees fir to the invariable detriment of the insureds, the Complainant, and ultimately the tax paying citizens of this State that bear the expense of the judicial system, which needs to be unraveled due to the tangled web created by ASIC.
Comments
User Id Date Added Comment
andrea.aguilar@hklaw.com 12-20-2024 VIA UPLOAD onto DFS website Florida Department of Financial Services Division of Insurance Regulation Consumer Assistance / Civil Remedy Section Larson Building, 200 East Gaines Street Tallahassee, Florida 32399-0322 Re: CIVIL REMEDY NOTICE OF INSURER VIOLATION DOI File No.: 788266 Complainant: Jorge Agustin Claim No.: 00201794831 Filed by: Erika Pardo, Esq. Reported DOL: September 28, 2022 Dear Sir or Madam: American Security Insurance Company (“American Security”) received the Civil Remedy Notice of Insurer Violation (“CRN”) submitted by Erika Pardo, Esq., on behalf of Jorge Agustin (“Complainant”) accepted by the Department of Financial Services (the “Department”) on October 23, 2024. This matter relates to claim number 00201794831 (the “Claim”) reported under certificate number 2MR21191540690 (the “Certificate”) issued by American Security to Wells Fargo Bank, N.A., its successors and/or assigns (the “Lender”) as the “Named Insured” and Complainant as the “Borrower” which insured the dwelling located at 3100 Broward Avenue, Greenacres, Florida, 33463 (the “Property”) as further set forth therein from June 27, 2022 through June 27, 2023. The Certificate provides $214,000.00 in dwelling coverage for damages to the Property, but did not provide coverage for personal property or additional living expenses. As a general matter, American Security objects to the validity of the CRN, as it is deficient on its face. The CRN lacks the specificity required by s. 624.155(3)(a), Florida Statutes. The CRN provides nothing more than vague, ambiguous and conclusory allegations regarding what Complainant believes to be American Security’s motivations, positions and business practices – none of which are true or supported by any facts. Florida law is clear that a claimant is required to state with specificity the “facts and circumstances giving rise to the violation,” to allow the insurer to understand and cure any purported violation. Longpoint Condo. Assn. v. Allstate Ins. Co., 2005 WL 1315810 (N.D. Fla. 2005). A written CRN which is vague and “shotgun” in nature or is written in general terms fails the specificity requirement of the statute. See Heritage Corp. of South Fla. v. National Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294, 1300 (S.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. 2010); Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The very purpose of the civil remedy notice, pursuant to Chapter 624, is to inform the insurer of alleged violations with specific information to encourage settlement of the subject claim. “The sixty-day window [as provided for in F.S. §624.155] is designed to be a cure period that will encourage payment of the underlying claim, and avoid unnecessary bad faith litigation.” Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000). Notice sent to the Department of Insurance concerning settlement violation(s) is intended to serve as a basis for the Department to assist in the settling of claims and to monitor the insurance industry. Id. However, whenever a complainant provides little in the way of adequate notice, the statutory intent of the CRN is frustrated. On May 28, 2024, Complainant’s counsel reported Hurricane Ina damages to the Property with a reported date of loss of September 28, 2022 – twenty (20) months earlier. American Security acknowledged receipt of the Claim, in writing, and assigned claim number 00201794831 to the reported loss. On May 29, 2024, American Security sent a Reservation of Rights letter based upon the late reporting in breach of the Duties After Loss. Days prior to reporting the Claim, Complainant retained Full Pro Restoration (“FPR”), to install a tarp and perform mitigation services exceeding $9,000.00 in remediation services. It was not until these services were completed that Complainant’s representative reported the Claim to American Security. FPR intentionally put the tarp on the roof immediately before the Claim was reported – notwithstanding that the house did not have a tarp on the roof for almost two years – with the intention of sending a second invoice to remove and re-tarp so that Complainant could show the alleged damages to the roof. Here FPR sent a second invoice for $5,000.00 to remove and replace the tarp. Upon receiving notice of the Claim, American Security retained an independent adjuster to inspect the Property. The first time the Property was made available for inspection was June 11, 2024. However, as the roof was tarped at the time of the inspection, a second inspection had to be scheduled on June 28, 2024. At the time of the inspection, there was minor damage to the roof and interior of the Property. Based upon the information available more than 21 months after the loss, American Security sent an explanation of benefits letter dated July 11, 2024, advising that it was covering the loss and included an itemized estimate for $7,069.58 (“RCV”), and tendered $1,395.96, after the estimate was offset by the wind deductible and recoverable depreciation. Due to Complainant’s multiple breaches of his duties after loss, American Security was prejudiced with determining coverage and the scope of the damages, and covered only that portion of the property that it could reasonably determine sustained direct physical damages as a result of the reported loss. American Security also tendered an negotiated settlement about with FPR in the amount of $13,553.08. Without further communication, without providing any notice that Complainant was disputing the amount of the loss, and without submitting a supplemental claim in accordance with Florida law and terms of the Certificate, Complainant submitted this CRN alleging that American Security acted in bad faith. Moreover, at no time prior to filing the CRN did Complainant and/or his representatives advise that repairs had been completed or that additional amounts were needed to complete repairs warranting the release of recoverable depreciation. Instead, following the filing of the CRN, Complainant submitted a Notice of Intent to Initiate Litigation and submitted with the Notice a $83,994.49 damage estimate dated June 2024. Pursuant to Fla. Stat. 627.70152, the Notice and the estimate submitted with the estimate does not constitute notice of a supplemental claim. Importantly, as there was no notice that Complainant was making a supplemental claim, American Security, as a matter of law and fact, was not in breach of the Certificate and did not do anything that would constitute bad faith. Indeed, Complainant is the only one who has acted in bad faith. Here, Complainant failed to report the Claim for twenty (20) months then, it appears, intentionally did not communicate any notice that he was making a supplemental claim and disputing the amount of the loss and intentionally withheld an estimate that was prepared in June 2024 and not provided prior to the filing of the CRN. This bad faith conduct in withholding an estimate and not providing notice of a supplemental claim prior to filing a CRN, is a pattern and practice of this law firm As such, the CRN is a nullity as a matter of law. Despite American Security’s good faith investigation of the Claim, Complainant lists a number of reasons for submitting the CRN, many of which are inaccurate and/or completely devoid of facts – which further reflects the boilerplate nature of the allegations being asserted against American Security. The CRN incorrectly states that American Security has not conducted an investigation regarding the mitigation services conducted by FPR. However, as set forth above, American Security issued payment to FPR for the mitigation services performed at the Property in relation to the Claim. The CRN alleges that American Security’s coverage determination was insufficient and references an estimate of damages in the amount of $83,994.49. At no point prior to the filing of the CRN did Complainant advise American Security that it was disputing the coverage determination or provide the estimate on which it relies. Further, Complainant did not provide American Security with the estimate until after the filing of the CRN. The CRN references policy language providing coverage for sudden and accidental losses and damages arising from a sudden and accidental plumbing system failure, which is completely inapplicable to the damage at issue in the Claim. Moreover, Complainant cites statutory provisions under Fla. Stat. § 624.155 and Fla. Stat. § 626.9541, without any ultimate facts that support the empty and false accusations. As such, American Security rejects the same as vague and statutorily non-compliant, and further responds as follows: 624.155(1)(b)(1): Denied. American Security conducted an investigation of the Claim and extended coverage in accordance with the terms, conditions and exclusions of the Certificate. American Security has acted fairly and honestly towards the Complainant with due regard for his interests at all times. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 624.155(1)(b)(3): Denied. American Security extended coverage for the Claim in accordance with the terms, conditions and exclusions of the Certificate. Complainant failed to dispute the amount of the loss or submit an estimate of damage prior to filing the CRN. American Security has never attempted to settle a claim under one portion of the insurance certificate in order to influence settlements under other portions of the insurance certificate. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(a): Denied. American Security has never failed to adopt and implement standards in such a way that would constitute a business practice. To the contrary, American Security conducted a investigation of the Claim and extended coverage in accordance with the terms, conditions and exclusions of the Certificate. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(b): Denied. American Security has never misrepresented facts or insurance policy provisions relating to the coverage at issue to Complainant. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(f): Denied. This allegation is based upon a false predicate and without merit as American Security extended coverage for the Claim pursuant to the terms, conditions and exclusions of the Certificate and provided a reasonable explanation in writing to Complainant which explained the basis for coverage. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. American Security denies all the allegations in the CRN as false, unfounded and completely devoid of merit or factual predicate. At no time has American Security ever acted in bad faith. At all times material to this Claim, American Security: (a) acted in good faith to investigate the Claim, acted fairly and honestly in its dealings with the Complainant and her representatives; (b) promptly investigated the Complainant’s Claim; (c) acknowledged and acted promptly in response to all communications with the Complainant; and (d) complied with its obligations in accordance with the terms of the subject insurance contract and Florida law. If you are in need of or seek any further information, please feel free to contact the undersigned. Very truly yours, /s/ Andrea N. Aguilar cc: Erika Pardo, Esq. Alaine S. Greenberg
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