Civil Remedy Notice of Insurer Violations
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Filing Number:     788693
Filing Accepted:  10/25/2024
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Complainant
Last/Business Name *  
GAINES   First Name   GERTRUDE
Street Address * 19607 MIDWAY BOULEVARD
City, State Zip * PORT CHARLOTTE, FL 33948
Email Address * FIRM@FLORIDAINSLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GAINES   First Name   GERTRUDE
Policy # * AIG10108248 Claim #* CDP00148468
Attorney
Attorney is Applicable
Last Name* CIOCCHETTI First Name * MICHAEL Initial
Street Address* 125 N. RIDGEWOOD AVENUE, SUITE 100
City, State Zip* DAYTONA BEACH , FLORIDA 32114
Email Address * FIRM@FLORIDAINSLAW.COM
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):* BRAD MCCLAIN, ANDREW KOPICZ
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

COVERAGE A – Dwelling We cover: 1. The dwelling on the Described Location shown in the Declarations, used principally for dwelling purposes, including structures attached to the dwelling; 2. Materials and supplies located on or next to the Described Location used to construct, alter or repair the dwelling or other structures on the Described Location; and 3. If not otherwise covered in this policy, building equipment and outdoor equipment used for the service of and located on the Described Location.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This complaint is made on behalf of the insured, GERTRUDE GAINES. Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy pursuant to Florida Statute §624.155. In consideration of the premium paid to it, the carrier, AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA (“Carrier”), issued a policy, Policy No. AIG10108248, to GERTRUDE GAINES (“Insured”) where the policy provided coverage for all losses, except those losses which were expressly excluded, for the property located at 19607 Midway Blvd, Port Charlotte, FL 33948. The policy was in full force and effect at the time the damage occurred from Hurricane Ian, and the ensuing damages as a direct result thereof, to the Insured Property, on or about September 28, 2022. Thereafter, the Carrier was timely notified of the Loss. In particular, the Carrier was put on notice of covered direct damages and ensuing damages and of the request that a claim be opened pursuant to the terms and conditions of the Policy. Claim number CDP00148468 (“Claim”) was assigned to the Loss. The Carrier sent an adjuster to the Insured Property to perform an inspection. The Carrier performed a cursory inspection of the Insured Property and failed to retain unbiased experts necessary to scope the entirety of the Loss and covered repairs necessary to restore the Insured Property to its pre-loss condition. This was done deliberately by the Carrier to undervalue portions of the claim. The Carrier knows its aforementioned investigation is insufficient and that it has failed to provide proper payment to restore the property to its pre-loss condition. This inspection placed The Carrier on notice of the severity of the Loss. Thereafter, the insured sought the assistance of a public adjuster who ensured the proper estimating of the loss and compliance with all Policy conditions. The public adjuster submitted a comprehensive estimate to the Carrier for the full scope of damages to the Insured Property. In addition, a Sworn Statement and Proof of Loss (“SPOL”) was provided, on or about September 11, 2024. The Carrier disregarded this comprehensive estimate and SPOL and, instead, underpaid the Claim. The Carrier has refused to reassess its payment of benefits and the basis of the payment and has refused to properly adjust and settle the Claim. The Carrier violated the provisions of Florida Statute §624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim when, under all circumstances, it could and should have done so had it acted fairly and honestly toward its insured with a due regard for their interest. When the Carrier was confronted with a comprehensive estimate and verifiable cause of Loss, the Carrier chose to underpay the Insured’s valid Claim for extensive damages that exceed the amount paid. The Carrier violated the provisions of Florida Statute §626.9541(1)(i)(2) by materially misrepresenting to the Insured that Policy coverage was unavailable for the Insured’s Claim and Loss to the Insured Property. This misrepresentation was made in an attempt to underpay the Insured’s Claim and escape without paying for the full extent of substantial damage. The Carrier violated the provisions of Florida Statute §626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. When confronted with a comprehensive estimate and verifiable cause of Loss, the Carrier apparently had no system or standards prepared or implemented which would allow it to evaluate the Claim as submitted by its Insured. The Carrier violated the provisions of Florida Statute §626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to the coverage at issue. This has been discussed fully hereinabove. The Carrier has refused to properly assess its payment of benefits and the basis of payment and has refused to properly adjust and settle the claim constituting unfair claim settlement practices under Florida Statute §626.9541(1)(i)(3)(i). The Carrier can cure these violations by payment, within 60 days of the date hereof, of all funds contractual owed to the Insured under the terms and conditions of the Policy.
Comments
User Id Date Added Comment
taylor@floridainslaw.com 04-28-2025 The Carrier has resolved the Civil Remedy Notice to the satisfaction of the Insured, and the Insured hereby withdraws the instant CRN.
swozniak@aii.com 11-14-2024 November 14, 2024 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, FL 32399-0322 Michael Ciocchetti, Esq. 125 North Ridgewood Avenue Suite 100 Daytona Beach, FL 32114 Firm@FloridaInsLaw.com Re: DFS File No: 788693 Complainant: Gertrude Gaines Insured: Gertrude Gaines Policy No: AGD10108248 Insurer: American Integrity Insurance Company of Florida Claim No: CDP-00148468 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Michael Ciocchetti, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on October 25, 2024 and assigned it DFS File No. of 788693. 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 Insured, Gertrude Gaines. 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: Michael Ciocchetti, Esq. via email at: Firm@FloridaInsLaw.com 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.

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