Civil Remedy Notice of Insurer Violations
Login

Filing Number:     788867
Filing Accepted:  10/26/2024
         Print Filing
Complainant
Last/Business Name *  
REGENCY GARDENS CONDOMINIUM ASSOCIATION, INC.   First Name  
Street Address * 4400 THORNBRIAR LANE (MULTIPLE LOCATIONS)
City, State Zip * ORLANDO, FL 32822
Email Address * HEW@HGWLEGAL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   REGENCY GARDENS CONDOMINIUM ASSOCIATION, INC.   First Name  
Policy # * AMC-37034-03 Claim #* 4199716
Attorney
Attorney is Applicable
Last Name* WOODWARD First Name * HEW Initial
Street Address* PO BOX 140312
City, State Zip* ORLANDO , FL 32814
Email Address * PLEADINGS@HGWLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN COASTAL INSURANCE COMPANY
NAIC Company Code 12968
 
Name of individual responsible for violation (if any):* HELEN SINGLETARY AND ARIAN ALVAREZ
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(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.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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).
626.9541(1)(i)(3)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
* 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 SUBJECT INSURANCE POLICY PROVIDES COVERAGE FOR DIRECT PHYSICAL LOSS TO REGENCY GARDENS CONDOMINIUM ASSOCIATION, INC.’S PROPERTY. REGENCY GARDENS SUBMITTED A CLAIM FOR WINDSTORM AND ASSOCIATED WATER DAMAGE TO ITS INSURED PROPERTY THAT OCCURRED DURING THE EFFECTIVE POLICY PERIOD. THE LOSS IS NOT EXCLUDED UNDER THE TERMS AND CONDITIONS OF THE POLICY. THE INSURER HAS FAILED TO ISSUE PAYMENT PURSUANT TO THE LOSS SETTLEMENT PROVISIONS OF THE POLICY. THE FOLLOWING COVERAGES AND POLICY LANGUAGE ARE RELEVANT: THIS IS A RESIDENTIAL CONDOMINIUM PROPERTY LOCATED IN ORLANDO, FL (ORANGE COUNTY). IT INCLUDES THE FOLLOWING BUILDINGS (HEREINAFER AFTER COLLECTIVELY REFERRED TO AS “PROPERTIES”), WITH THE FOLLOWING LIMITS AND/OR AGREED REPLACEMENT COST VALUES: 4400 THORNBRIAR LANE, ORLANDO, FL 32822 $ 1,719,200.00 5501 ROSEBRIAR WAY, ORLANDO, FL 32822 $ 2,940,100.00 4301 LIZSHIRE LANE, ORLANDO, FL 32822 $ 2,977,800.00 5530 CHRISHIRE WAY, ORLANDO, FL 32822 $ 1,845,700.00 4350 PERKSHIRE LANE, ORLANDO, FL 32822 $ 1,845,700.00 4200 THORNBRIAR LANE, ORLANDO, FL 32822 $ 2,607,100.00 5533 CHRISHIRE WAY, ORLANDO, FL 32822 $ 1,522,700.00 5601 ROSEBRIAR WAY, ORLANDO, FL 32822 $ 1,522,700.00 5500 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 1,734,700.00 5540 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 1,255,900.00 5545 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 1,675,100.00 4355 PERKINSHIRE LANE, ORLANDO, FL 32822 $ 1,675,100.00 5587 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 1,918,700.00 4460 PERKSHIRE LANE, ORLANDO, FL 32822 $ 1,675,100.00 5635 DEVONBRIER WAY, ORLANDO, FL 32822 $ 1,159,800.00 4275 PERKINSHIRE LANE, ORLANDO, FL 32822 $ 1,159,800.00 5600 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 2,334,900.00 4225 THORNBRIAR LANE, ORLANDO, FL 32822 $ 2,292,200.00 4367 THORNBRIAR LANE, ORLANDO, FL 32822 $ 1,826,400.00 4401 THORNBRIAR LANE, ORLANDO, FL 32822 $ 1,299,900.00 COVERED CAUSE OF LOSS: SPECIAL INCLUDING THEFT WINDSTORM OR HAIL: COVERED DEDUCTIBLE HURRICANE DEDUCTIBLE: 3% PER CALENDAR YEAR OPTIONAL COVERAGES VALUATION - BUILDING REPLACEMENT COST VALUE VALUATION - ROOFS REPLACEMENT COST VALUE ORDINANCE OR LAW INCLUDED CONDOMINIUM ASSOCIATION COVERAGE FORM A. COVERAGE WE WILL PAY FOR DIRECT PHYSICAL LOSS OR DAMAGE TO COVERED PROPERTY AT THE PREMISES DESCRIBED IN THE DECLARATIONS CAUSED BY OR RESULTING FROM ANY COVERED CAUSE OF LOSS. 3. COVERED CAUSES OF LOSS SEE APPLICABLE CAUSES OF LOSS FORM AS SHOWN IN THE DECLARATIONS. CAUSES OF LOSS – SPECIAL FORM A.COVERED CAUSES OF LOSS WHEN SPECIAL IS SHOWN IN THE DECLARATIONS, COVERED CAUSES OF LOSS MEANS RISKS OF DIRECT PHYSICAL LOSS UNLESS THE LOSS IS: 1.EXCLUDED IN SECTION B., EXCLUSIONS; OR 2.LIMITED IN SECTION C., LIMITATIONS; THAT FOLLOW. ORDINANCE OR LAW COVERAGE D. COVERAGE 1.COVERAGE A – COVERAGE FOR LOSS TO THE UNDAMAGED PORTION OF THE BUILDING 2.COVERAGE B – DEMOLITION COST COVERAGE 3.COVERAGE C – INCREASED COST OF CONSTRUCTION COVERAGE ORDINANCE OR LAW COVERAGE SCHEDULE 4400 THORNBRIAR LANE, ORLANDO, FL 32822 $ 171,920 5501 ROSEBRIAR WAY, ORLANDO, FL 32822 $ 294,010 4301 LIZSHIRE LANE, ORLANDO, FL 32822 $ 297,780 5530 CHRISHIRE WAY, ORLANDO, FL 32822 $ 184,570 4350 PERKSHIRE LANE, ORLANDO, FL 32822 $ 184,570 4200 THORNBRIAR LANE, ORLANDO, FL 32822 $ 260,710 5533 CHRISHIRE WAY, ORLANDO, FL 32822 $ 152,270 5601 ROSEBRIAR WAY, ORLANDO, FL 32822 $ 152,200 5500 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 173,470 5540 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 125,590 5545 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 167,510 4355 PERKINSHIRE LANE, ORLANDO, FL 32822 $ 167,510 5587 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 191,870 4460 PERKSHIRE LANE, ORLANDO, FL 32822 $ 167,510 5635 DEVONBRIER WAY, ORLANDO, FL 32822 $ 115,980 4275 PERKINSHIRE LANE, ORLANDO, FL 32822 $ 115,980 5600 DEVONBRIAR WAY, ORLANDO, FL 32822 $ 233,490 4225 THORNBRIAR LANE, ORLANDO, FL 32822 $ 229,220 4367 THORNBRIAR LANE, ORLANDO, FL 32822 $ 182,640 4401 THORNBRIAR LANE, ORLANDO, FL 32822 $ 129,990 PROPERTY ENHANCEMENT ENDORSEMENT DEBRIS REMOVAL…$50,000 WIND DRIVEN PRECIPITATION…$250,000 FUNGUS, WET ROT, DRY ROT AND BACTERIA…$50,000 G. OPTIONAL COVERAGES 1. AGREED VALUE 2. INFLATION GUARD 3. REPLACEMENT COST A. REPLACEMENT COST (WITHOUT DEDUCTION FOR DEPRECIATION) REPLACES ACTUAL CASH VALUE IN THE LOSS CONDITION, VALUATION, OF THIS COVERAGE FORM. L. WIND DRIVEN PRECIPITATION…YOU MAY EXTEND THE INSURANCE PROVIDED BY THIS COVERAGE FORM TO COVER WIND DRIVEN PRECIPITATION. WIND DRIVEN PRECIPITATION IS DEFINED AS LOSS OR DAMAGE TO THE INTERIOR OF ANY BUILDING OR STRUCTURE, OR TO PERSONAL PROPERTY IN THE BUILDING OR STRUCTURE CAUSED BY OR RESULTING FROM RAIN, SNOW, SLEET, OR ICE, WHEN DRIVEN BY WIND. LIBERALIZATION CLAUSE…IF WE ADOPT ANY REVISION THAT WOULD BROADEN THE COVERAGE UNDER THIS COVERAGE PART WITHOUT ADDITIONAL PREMIUM WITHIN 45 DAYS PRIOR TO OR DURING THE POLICY PERIOD, THE BROADENED COVERAGE WILL IMMEDIATELY APPLY TO THIS COVERAGE PART. LOSS PAYMENT…WE WILL PAY FOR COVERED LOSS OR DAMAGE UPON THE EARLIEST OF THE FOLLOWING: (1) WITHIN 20 DAYS AFTER WE RECEIVE THE SWORN PROOF OF LOSS AND REACH WRITTEN AGREEMENT WITH YOU; (2) WITHIN 30 DAYS AFTER WE RECEIVE THE SWORN PROOF OF LOSS AND: - (A) THERE IS AN ENTRY OF A FINAL JUDGMENT; OR - (B) THERE IS A FILING OF AN APPRAISAL AWARD WITH US; OR (3) WITHIN 90 DAYS OF RECEIVING NOTICE OF AN INITIAL, "REOPENED," OR "SUPPLEMENTAL CLAIM," UNLESS WE DENY THE CLAIM DURING THAT TIME OR FACTORS BEYOND OUR CONTROL REASONABLY PREVENT SUCH PAYMENT. IF A PORTION OF THE CLAIM IS DENIED, THEN THE 90-DAY TIME PERIOD FOR PAYMENT OF CLAIM RELATES TO THE PORTION OF THE CLAIM THAT IS NOT DENIED. ALL OF THE PROVISIONS IN THE SUBJECT INSURANCE POLICY ARE DICTATED BY THE FOLLOWING FLORIDA STATUTES: § 627.4025 (“RESIDENTIAL COVERAGE AND HURRICANE COVERAGE DEFINED”); § 627.404 (“INSURABLE INTEREST, PERSONAL INSURANCE”); § 627.405 (“INSURABLE INTEREST”); § 627.4091 (“SPECIFIC REASONS FOR DENIAL, CANCELLATION, OR NONRENEWAL”); § 627.40951 (“STANDARD PERSONAL LINES RESIDENTIAL INSURANCE POLICY”); § 627.410 (“FILING, APPROVAL OF FORMS”); § 627.412 (“STANDARD PROVISIONS, IN GENERAL”); § 627.413 (“CONTENTS OF POLICIES, IN GENERAL”); § IDENTIFICATION”); § 627.4131 (“TELEPHONE NUMBER REQUIRED”); § 627.4133 (“NOTICE OF CANCELLATION, NONRENEWAL, OR RENEWAL PREMIUM”); § 627.4135 (“CASUALTY INSURANCE CONTRACTS SUBJECT TO GENERAL PROVISIONS FOR INSURANCE CONTRACTS”); § 627.4143 (“OUTLINE OF COVERAGE”); § 627.4145 (“READABLE LANGUAGE IN INSURANCE POLICIES”); § 627.418 (“VALIDITY OF NONCOMPLYING CONTRACTS”); § 627.419 (“CONSTRUCTION OF POLICIES”); § 627.420 (“BINDERS”); § 627.421 (“DELIVERY OF POLICY”); § 627.425 (“FORMS FOR PROOF OF LOSS TO BE FURNISHED”); § 627.426 (“CLAIMS ADMINISTRATION”); § 627.4265 (“PAYMENT OF SETTLEMENT”); § 627.428 (“ATTORNEY'S FEE”); § 627.442 (“INSURANCE CONTRACTS”); § 627.7011 (“HOMEOWNERS' POLICIES, OFFER OF REPLACEMENT COST COVERAGE AND LAW AND ORDINANCE COVERAGE”); § 627.7015 (“ALTERNATIVE PROCEDURE FOR RESOLUTION OF DISPUTED PROPERTY INSURANCE CLAIMS”); § 627.7016 (“INSURER CONTRACTS WITH BUILDING CONTRACTORS”); § 627.7019 (“STANDARDIZATION OF REQUIREMENTS APPLICABLE TO INSURERS AFTER NATURAL DISASTERS”); § 627.702 (“VALUED POLICY LAW”); § 627.7061 (“COVERAGE INQUIRIES”); § 627.707 (“STANDARDS FOR INVESTIGATION OF SINKHOLE CLAIMS BY INSURERS. NONRENEWALS”); § 627.7072 (“TESTING STANDARDS FOR SINKHOLES”); § 627.7073 (“SINKHOLE REPORTS”); § 627.712 (“RESIDENTIAL WINDSTORM COVERAGE REQUIRED, AVAILABILITY OF EXCLUSIONS FOR WINDSTORM OR CONTENTS”).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

AMERICAN COASTAL INSURANCE COMPANY (“AMERICAN COASTAL” OR “INSURER”) BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES DURING ITS ADJUSTMENT OF THE INSURANCE CLAIM REPORTED BY REGENCY GARDENS CONDOMINIUM ASSOCIATION, INC. (THE “INSURED” OR “INSUREDS”) IN CONNECTION WITH SEVERE DAMAGE TO THE SCHEDULED LOCATIONS IDENTIFIED ABOVE ("PROPERTIES" OR “INSURED PROPERTY”) CAUSED BY WINDSTORM AND WATER INTRUSION OCCURING ON OR ABOUT SEPTEMBER 28, 2022 (“LOSS”). THE SUBJECT INSURANCE POLICY PROVIDES COVERAGE FOR THIS LOSS. REGENCY GARDENS SUBMITTED A VALID CLAIM FOR WINDSTORM AND WATER DAMAGE TO THE PROPERTIES THAT OCCURRED DURING THE EFFECTIVE POLICY PERIOD. THE LOSS IS NOT EXCLUDED UNDER THE TERMS AND CONDITIONS OF THE POLICY. AMERICAN COASTAL HAS FAILED TO ISSUE PAYMENT PURSUANT TO THE LOSS SETTLEMENT PROVISIONS OF THE POLICY. AS SET FORTH IN GREATER DETAIL BELOW, AMERICAN COASTAL ALSO VIOLATED THE MINIMUM STATUTORY AND CONTRACTUAL DUTIES THAT IT OWED TO THE INSURED, INCLUDING BUT NOT LIMITED TO THE FOLLOWING WAYS: FAILING TO INVESTIGATE THE CLAIMED DAMAGES TO THE INSURED PROPERTY WITH OBJECTIVE AND QUALIFIED EXPERTS AND ADJUSTERS; FAILING TO ADJUST THE CLAIMED DAMAGES AND EXPENSES IN AN OBJECTIVE AND REASONABLE MANNER; REFUSING TO ACKNOWLEDGE AND MEANINGFULLY RESPOND TO COMMUNICATIONS; REFUSING TO COMMUNICATE REASONABLE REQUESTS FOR DOCUMENTS AND INFORMATION; REFUSING TO PAY ALL UNDISPUTED AMOUNTS OWED; REFUSING TO PROVIDE REPORTS AND INFORMATION THAT WOULD ENABLE THE INSURED TO MEANINGFULLY EVALUATE THE NATURE AND SCOPE OF DAMAGE; REFUSING TO PAY INSURANCE BENEFITS TO REPAIR ALL OF THE DAMAGED PROPERTY COVERED BY THE INSURANCE POLICY, WHEN THE OBLIGATION TO ISSUE SUCH PAYMENT WAS APPARENT. AMERICAN COASTAL ISSUED AN “ALL RISK” INSURANCE POLICY TO THE INSURED. ACCORDINGLY, THE INSURANCE POLICY MUST BE READ TO PROVIDE COVERAGE FOR ANY AND ALL DAMAGE TO THE INSURED PROPERTY THAT IS NOT CLEARLY AND UNAMBIGUOUSLY EXCLUDED UNDER THE INSURANCE POLICY. MOREOVER, THE PROVISIONS OF THE “ALL RISK” POLICY PROVIDING COVERAGE ARE TO BE CONSTRUED BROADLY, WHILE THE EXCLUSIONARY LANGUAGE OF THE INSURANCE POLICY ARE TO BE READ NARROWLY AND STRICTLY. AMERICAN COASTAL REFUSES TO ACKNOWLEDGE OR ADMIT THE BASIC TENETS OF THE ALL RISK POLICY THAT IS SOLD TO THE INSURED. IN FACT, IT WAS AMERICAN COASTAL'S OBLIGATION TO AFFIRMATIVELY POINT OUT POLICY BENEFITS AVAILABLE TO ITS INSUREDS, DESPITE THE FACT THAT THE INSURED OR THE INSURED’S REPRESENTATIVE MAY NOT HAVE BEEN AWARE OF SUCH BENEFITS. THE INSURING AGREEMENT IS INTENDED TO PROVIDE THE INSURED WITH PEACE OF MIND AND THE INSURANCE COMPANY IS EXPECTED TO FACILITATE THAT INTENTION. AMERICAN COASTAL HAS REFUSED TO PAY BENEFITS FOR DAMAGE TO THE INSURED PROPERTY CAUSED BY THE LOSS (AMONG OTHERS). AMERICAN COASTAL HAS NOT PAID FULL REPLACEMENT COST BENEFITS AND HAS ABUSED THE CLAIM INVESTIGATION PROCESS TO EVADE PAYING ALL UNDISPUTED AMOUNTS OWED ON THE INSUREDS’ CLAIM. AMERICAN COASTAL HAS NOT PROVIDED A COMPREHENSIVE REPORT SETTING FORTH THE CAUSE AND ORIGIN OF THE DAMAGES. RATHER, AMERICAN COASTAL HAS PROVIDED ESTIMATES OF THE REPAIR COSTS, BUT HAS REFUSED TO PAY BENEFITS EQUIVALENT TO ITS ESTIMATES. IN FACT, AMERICAN COASTAL REFUSES TO ACKNOWLEDGE OR ADMIT THE BASIC TENANTS OF THE REPLACEMENT COST COVERAGE THAT IS SOLD TO THE INSUREDS. UNDER THESE CIRCUMSTANCES, THE INSURED IS UNABLE TO COMMENCE PERMANENT REPAIRS. AS SET FORTH BELOW, AMERICAN COASTAL’S CONDUCT BEFORE, DURING AND AFTER RECEIVING NOTICE OF THE CLAIM SHOWS THAT IT MADE A PRECONCEIVED DETERMINATION TO STALL, DELAY, UNDERPAY OR DENY ALL OR PART OF THE CLAIM BASED ON SPECULATION AND CONJECTURE, AS OPPOSED TO ADJUSTING THIS CLAIM IN GOOD FAITH AND PAYING THE INSURANCE BENEFITS IT OWES. AMERICAN COASTAL HAS NOT PROVIDED A VALUE TO THE INSURED FOR REPAIRS TO THE PROPERTIES (INCLUDING UPGRADES REQUIRED BY THE BUILDING CODES). AMERICAN COASTAL HAS NOT PAID OR HAS GROSSLY UNDERPAID THE CLAIM FOR DAMAGES SUSTAINED. AMERICAN COASTAL HAS NOT RESPONDED TO THE INSUREDS REQUESTS FOR INFORMATION ABOUT THE CLAIM AND HAS MISLED THE INSURED AS TO REPAIRS. ON OR ABOUT OCTOBER 19 AND 20, 2022, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. THE INSURED REQUESTED A CERTIFIED COPY OF THE POLICY, THE CLAIMS HISTORY, CORRESPONDENCE, ESTIMATES, STATEMENTS OF LOSS, ITEL REPORTS, ENGINEERING REPORTS, CLAIM PAYMENTS, AND INSPECTION REPORTS FROM THE UNDERWRITING FILE, AND A STATEMENT OF ALL COVERAGE LIMITATIONS OR EXCLUSIONS THAT APPLY TO THE LOSS. AMERICAN COASTAL FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT NOVEMBER 1, 9 AND 16, 2022, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT NOVEMBER 19 AND 21, 2022, THE INSURED (OR ITS REPRESENTATIVES) AND AMERICAN COASTAL (OR ITS REPRESENTATIVES) INSPECTED THE DAMAGED PROPERTY. DURING THE INSPECTION, THE INSURED REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. DURING THE INSPECTION AMERICAN COASTAL ACKNOWLEDGED SEVERE DAMAGE TO ALL OF THE BUILDINGS. MOREOVER, AMERICAN COASTAL ADVISED THAT CERTAIN DAMAGES WERE EXCLUDED, BUT PROVIDED NO EVIDENCE IN SUPPORT OF ITS PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. HOWEVER, AMERICAN COASTAL HAD NOT RETAINED ANY EXPERTS TO DETERMINE THE CAUSE AND ORIGIN OF THE DAMAGE, AND IT FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JANUARY 3 AND 16, 2023, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT APRIL 13 AND 19, 2023, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT APRIL 27, 2023 OR MAY 3, 2023 (APPROXIMATELY 196-DAYS AFTER FIRST NOTICE OF LOSS), AMERICAN COASTAL (OR ITS REPRESENTATIVES) ISSUED A LETTER TO THE INSURED STATING THAT IT’S CONSULTANTS HAD CONFIRMED DAMAGES TO THE PROPERTIES AND DETERMINED AGREED TO ISSUE PAYMENT IN THE AMOUNT OF $37,560.32. THIS PAYMENT DID NOT INCLUDE INTEREST, MUCH LESS ANY BENEFITS FOR TEMPORARY REPAIRS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, HOWEVER, IT REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. IN FACT, IT APPEARS THAT AMERICAN COASTAL CLOSED ITS FILE AT THAT TIME. ON OR ABOUT JUNE 27, 2023, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JULY 6, 2023, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT AUGUST 8, 2023, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT OCTOBER 2, 3, 4 AND 5, 2023, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT NOVEMBER 7, 2023, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT DECEMBER 13, 2023, THE INSURED (OR ITS REPRESENTATIVES) AND AMERICAN COASTAL (OR ITS REPRESENTATIVES) INSPECTED THE DAMAGED PROPERTY. DURING THE INSPECTION, THE INSURED REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL ACKNOWLEDGED SEVERE DAMAGE TO ALL OF THE BUILDINGS BUT FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JANUARY 25, 2024 (APPROXIMATELY 463-DAYS AFTER FIRST NOTICE OF LOSS), THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT FEBRUARY 16 AND 22, 2024, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT MARCH 12 AND 18, 2024, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT MARCH 30, 2024 (APPROXIMATELY 528-DAYS AFTER FIRST NOTICE OF LOSS), AMERICAN COASTAL (OR ITS REPRESENTATIVES) ISSUED A LETTER CONFIRMING RECEIPT OF THE INSURED’S SWORN STATEMENT IN PROOF LOSS TOTALING $2,390,036 AND SUPPORTING DOCUMENTATION. HOWEVER, AMERICAN COASTAL REFUSED TO ISSUE PAYMENT AND STATED THAT IT “NEITHER ACCEPTS NOR REJECTS THE SWORN STATEMENT IN PROOF OF LOSS.” NEITHER FLORIDA LAW NOR THE SUBJECT INSURANCE POLICY PERMITS AMERICAN COASTAL TO DISPOSE OF A CLAIM IN SUCH A MANNER. MOREOVER, AMERICAN COASTAL ADVISED THAT CERTAIN DAMAGES WERE EXCLUDED, BUT PROVIDED NO EVIDENCE IN SUPPORT OF ITS PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. HOWEVER, AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT APRIL 16 AND 18, 2024, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT APRIL 25 AND 26, 2024, THE INSURED RE-SUBMITTED THE SWORN STATEMENT IN PROOF OF LOSS TOTALING $2,390,036, TOGETHER WITH SUPPORTING DOCUMENTATION INCLUDING BUT NOT LIMITED TO A 624-PAGE ENGINEERING REPORT, PHOTOGRAPHS, DIAGRAMS, INVOICES AND ESTIMATES. THE INSURED ALSO REQUESTED PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, TOGETHER WITH SUPPORTING INVOICES AND PHOTOGRAPHS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT MAY 28, 2024 (APPROXIMATELY 587-DAYS AFTER FIRST NOTICE OF LOSS), AMERICAN COASTAL (OR ITS REPRESENTATIVES) ISSUED A LETTER AGAIN CONFIRMING RECEIPT OF THE INSURED’S SWORN STATEMENT IN PROOF LOSS AND SUPPORTING DOCUMENTATION. HOWEVER, AMERICAN COASTAL REFUSED TO ISSUE PAYMENT AND STATED THAT IT “NEITHER ACCEPTS NOR REJECTS THE SWORN STATEMENT IN PROOF OF LOSS.” NEITHER FLORIDA LAW NOR THE SUBJECT INSURANCE POLICY PERMITS AMERICAN COASTAL TO DISPOSE OF A CLAIM IN SUCH A MANNER. MOREOVER, AMERICAN COASTAL ADVISED THAT CERTAIN DAMAGES WERE EXCLUDED, BUT PROVIDED NO EVIDENCE IN SUPPORT OF ITS PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. MOREOVER, AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JUNE 6, 2024 (APPROXIMATELY 596-DAYS AFTER FIRST NOTICE OF LOSS), AMERICAN COASTAL (OR ITS REPRESENTATIVES) ISSUED A LETTER STATING THAT IT “WILL BE RETAINING AN ENGINEER AND BUILDING CONSULTANT TO COMPLETE A RE-INSPECTION OF THE PROPERTY.” HOWEVER, AMERICAN COASTAL REFUSED TO ISSUE ANY FURTHER UNDISPUTED PAYMENTS. MOREOVER, AMERICAN COASTAL ADVISED THAT CERTAIN DAMAGES WERE EXCLUDED, BUT PROVIDED NO EVIDENCE IN SUPPORT OF ITS PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. LIKEWISE, AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JUNE 11, 13, 17, AND 20, 2024, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JULY 15, 16, 25 AND 26, 2024, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JULY 26, 2024 (APPROXIMATELY 646-DAYS AFTER FIRST NOTICE OF LOSS), AMERICAN COASTAL (OR ITS REPRESENTATIVES) ISSUED ANOTHER LETTER STATING THAT IT “WILL BE RETAINING AN ENGINEER AND BUILDING CONSULTANT TO COMPLETE A RE-INSPECTION OF THE PROPERTY.” HOWEVER, AMERICAN COASTAL REFUSED TO ISSUE ANY FURTHER UNDISPUTED PAYMENTS. MOREOVER, AMERICAN COASTAL ADVISED THAT CERTAIN DAMAGES WERE EXCLUDED, BUT PROVIDED NO EVIDENCE IN SUPPORT OF ITS PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. LIKEWISE, AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JUNE 19, JULY 12 AND JULY 30, 2024, THE INSURED SUBMITTED AND RE-SUBMITTED THE ENGINEERING REPORT, PHOTOGRAPHS, DIAGRAMS, INVOICES AND ESTIMATES SUPPORTING THE SWORN STATEMENT IN PROOF OF LOSS. THE INSURED ALSO REQUESTED PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, TOGETHER WITH SUPPORTING INVOICES AND PHOTOGRAPHS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT AUGUST 21, 2024, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT SEPTEMBER 20 AND 23, 2024, THE INSURED (OR ITS REPRESENTATIVES) CONTACTED AMERICAN COASTAL (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. AMERICAN COASTAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT SETPTEMBER 24, 2024, THE INSURED ENGAGED LEGAL COUNSEL AND FILED A NOTICE OF INTENT TO INITIATE LITIGATION (“NOITL”) REQUESTING PAYMENT IN THE AMOUNT OF AT LEAST $2,413.676. THE INSURED FURTHER REQUESTED IMMEDIATE PAYMENT OF ALL UNDISPUTED AMOUNTS OWED ON THE CLAIM, AS WELL AS A CERTIFIED COPY OF THE SUBJECT AND THE “LOSS RUN STATEMENT” PURSUANT TO FLORIDA STATUTE § 627.444. DESPITE HAVING IN ITS POSSESSION SUFFICIENT INFORMATION, AMERICAN COASTAL DID NOT MAKE AN OFFER IN RESPONSE TO THE AMOUNT DEMANDED BY THE INSURED IN THE NOITL. AFTER RECEIVING THE NOITL, AMERICAN COASTAL DID NOT REINSPECT THE LOSS, DID NOT MAKE ANY SETTLEMENT OFFERS AND REFUSED TO PRODUCE THE REQUESTED DOCUMENTATION. ON OR ABOUT OCTOBER 7, 2024 (APPROXIMATELY 719-DAYS AFTER FIRST NOTICE OF LOSS), AMERICAN COASTAL (OR ITS REPRESENTATIVES) ISSUED A “SUPPLEMENTAL PAYMENT LETTER” TO THE INSURED STATING THAT IT HAD “COMPLETED OUR SUPPLEMENTAL INVESTIGATION AND TO PROVIDE OUR COVERAGE DETERMINATION.” THE LETTER ALSO MEMORIALIZED RECEIPT OF AN INVOICE FOR $61,200 FOR TARP REMOVAL SERVICES TO ACCOMMODATE AMERICAN COASTAL’S CONSULTANTS AND ENGINEERS. THE LETTER MEMORIALIZED ANOTHER PAYMENT IN THE AMOUNT OF $31,000 (BUT DID NOT INCLUDE ANY INTEREST), AND PROVIDED NO EXPLANATION AS TO WHY IT PAID ONLY $31,000 FOR TARP REMOVAL, OR WHY IT REFUSED TO REIMBURSE THE OTHER COSTS OF TEMPORARY REPAIRS. MOREOVER, THE LETTER STATES THAT IT WAS ENCLOSING “A COPY OF KEYSTONE’S ENGINEERING REPORT” IN SUPPORT OF IT DENIAL OF COVERAGE THIS WAS PATENTLY FALSE AND MISLEADING BECAUSE AMERICAN COASTAL DID NOT ENCLOSE AN ENGINEERING REPORTS, AND HAS NEVER PRODUCED AN ENGINEERING REPORT. IN ADDITION TO THESE MISREPRESENATIONS, AMERICAN COASTAL PROVIDED NO EXPLANATION AS TO WHY IT REFUSED TO PAY THE AMOUNTS SET FORTH IN ITS OWN “BUILDING CONSULTANT SUPPLEMENTAL REPORT” WHICH WAS ENCLOSED WITH THE LETTER. SPECIFICALLY, THE BUILDING CONSULTANT INSPECTED THE PROPERTY AND PERFORMED A PEER REVIEW OF AMERICAN COASTAL’S PRIOR ESTIMATES AND DETERMINED THAT AN ADDITOINAL $415,554.10 WAS DUE AND OWING ON THE CLAIM. ONCE AGAIN, AMERICAN COASTAL FAILED OR REFUSED TO ISSUE PAYMENT. IT ALSO FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S CLAIM SUBMISSIONS AND REQUESTS FOR DOCUMENTS AND INFORMATION. MOREOVER, IT REFUSED TO REIMBURSE THE COSTS OF ALL THE TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. AMERICAN COASTAL KNEW OR SHOULD HAVE KNOWN THAT ITS DELAYS AND REFUSAL TO ISSUE PAYMENT WOULD CAUSE UNDUE FINANCIAL DISTRESS. THESE TACTICS WERE PREMEDITATED WITH THE INTENT TO COERCE AN UNFAIR SETTLEMENT WITH THE INSURED. RATHER THAN ADJUSTING THE CLAIM IN GOOD FAITH, AMERICAN COASTAL STALLED AND DELAYED, IMPROPERLY UNDERVALUED THE CLAIM, MISREPRESENTED AND MISLED REGENCY GARDENS, AND MADE LOW-BALL PAYMENTS ON THE CLAIM. DESPITE CLEAR EVIDENCE THAT THE CLAIMED DAMAGES WERE COVERED BY THE SUBJECT INSURANCE POLICY, AND ITS OWN CONSULTANT’S ESTIMATES SHOWING THAT APPROXIMATELY $500,000 MORE WAS OWED ON THE CLAIM, AMERICAN COASTAL UNDERTOOK AN EXTENDED ADJUSTMENT PROCESS IN BAD FAITH, AND ULTIMATELY PAID A SMALL FRACTION OF THE BENEFITS OWED TO THE INSURED. THE INSURER’S FAILURE TO PROPERLY PAY ALL AMOUNTS DUE AND OWING UNDER THE APPROPRIATE COVERAGES HAS LED TO NON-PAYMENT OF REGENCY GARDENS’ CLAIM, IN ADDITION TO SUBSTANTIAL DELAYS. IT IS BELIEVED THAT THE INSURER’S ACTIONS DESCRIBED HEREIN ARE A GENERAL BUSINESS PRACTICE OF THE COMPANY. TO CURE THE DEFECTS OUTLINED IN THE CIVIL REMEDY NOTICE, THE INSURER MUST PROVIDE COVERAGE FOR THE COSTS TO COMPLETELY REPAIR THE PROPERTIES AND BRING THE PROPERTIES UP TO THE CURRENT BUILDING CODE (ORDINANCE AND LAW), AND TENDER PAYMENT FOR ALL CONTRACTUAL DAMAGES OWED. THE UNDERLYING CONCEPT OF INSURANCE IS THAT THE INSURER’S GRANTING OF TIMELY AND PROMPT INDEMNIFICATION OR SECURITY AGAINST A CONTINGENT LOSS PLACES THE INSURED BACK TO A PRE-LOSS CONDITION IN A TIMELY MANNER. HOWEVER, AMERICAN COASTAL'S CLAIMS REPRESENTATIVES AND ADJUSTER(S) DID NOT PERFORM AN ADEQUATE OR REASONABLE INVESTIGATION OF THE DAMAGES, AND AMERICAN COASTAL HAS PROVIDED NO REASONABLE EXPLANATION AS TO WHY PAYMENT FOR ALL OF THE DAMAGED PROPERTY WAS NOT ISSUED IN A TIMELY MANNER. AMERICAN COASTAL HAS VIOLATED THE FUNDAMENTAL RULE REQUIRING IT TO IMMEDIATELY PAY BENEFITS OWED ON A CLAIM, AND PROHIBITING IT FROM WITHHOLDING UNDISPUTED AMOUNTS OWED IN ORDER TO EFFECTUATE A BETTER SETTLEMENT OF THE REMAINDER OF THE CLAIM. AMERICAN COASTAL DENIED INSURANCE BENEFITS BASED UPON INSUFFICIENT INFORMATION, SPECULATION AND BIASED INFORMATION. THE FAILURE TO FAIRLY AND REASONABLY INVESTIGATE A CLAIM DOES NOT PERMIT AMERICAN COASTAL TO DENY THE CLAIM, OR REFUSE BENEFITS, DUE TO LACK OF INFORMATION OR ONE-SIDED INFORMATION. IT CANNOT JUST FOCUS ON FACTS THAT WOULD SUPPORT DENYING A CLAIM. AMERICAN COASTAL IGNORED EVIDENCE WHICH ESTABLISHES INSURANCE COVERAGE AND TRIGGERS THE PAYMENT OF INSURANCE BENEFITS. AMERICAN COASTAL WAS REQUIRED TO ACKNOWLEDGE THE INSURED’S CLAIM SUBMISSIONS AND, AT A MINIMUM, ADVISE THE INSURED THAT IT DISAGREED WITH THEIR CLAIM SUBMISSIONS BY IDENTIFYING THE AREAS OF DISAGREEMENT AND CONDUCTING AN ADDITIONAL INVESTIGATION OF THE CLAIM. IN FACT, AMERICAN COASTAL CANNOT IGNORE AN INSURED’S CLAIM SUBMISSIONS IN SUCH A MANNER. BY IGNORING THE INSURED’S CLAIM SUBMISSIONS, IT IS CLEAR THAT AMERICAN COASTAL MADE A PRECONCEIVED DETERMINATION TO UNDERPAY OR DENY ALL OR PART OF THE CLAIM BASED ON SPECULATION AND CONJECTURE, AND USED PREDICTABLE OR BIASED EXPERTS AND/OR ADJUSTERS TO DEVELOP DEFENSES TO THE CLAIM, AS OPPOSED TO ADJUSTING THIS CLAIM IN GOOD FAITH AND PAYING THE INSURED INSURANCE THE BENEFITS IT OWES. AMERICAN COASTAL’S BAD FAITH CONDUCT HAS EXACERBATED THE INSURED’S DAMAGES. DESPITE THE REQUESTS AND SUBMISSIONS MADE BY OR ON BEHALF OF THE INSURED, AMERICAN COASTAL FAILED AND REFUSED TO PROVIDE ANY MEANINGFUL RESPONSE TO THEIR CLAIM SUBMISSIONS. RATHER THAN REVIEWING THE REPORTS, ESTIMATES AND/OR INVOICES PROVIDED, AND PAYING THE REQUESTED INSURANCE BENEFITS, AMERICAN COASTAL EITHER COMPLETELY IGNORED OR TOTALLY DISMISSED THESE CLAIM SUBMISSIONS. PURSUANT TO THE TERMS, CONDITIONS AND COVERAGES OF THE SUBJECT INSURANCE POLICY, AMERICAN COASTAL WAS OBLIGATED TO INVESTIGATE AND INDEMNIFY THE INSURED IN FULL. YET, AFTER RECEIVING DETAILED INVOICES AND/OR ESTIMATES SUBSTANTIATING THE DAMAGES, AMERICAN COASTAL HAS MADE NO REASONABLE PAYMENTS AND HAS STALLED AND DELAYED PAYMENT ON THE CLAIM. AMERICAN COASTAL WAS OBLIGATED TO CONTINUE ITS ADJUSTMENT OF THE CLAIM AND ISSUE PAYMENTS TO REPAIR THE DAMAGE TO THE PROPERTIES THAT AMERICAN COASTAL BELIEVED TO BE CAUSED BY A COVERED LOSS. AT A MINIMUM, AMERICAN COASTAL SHOULD HAVE PREPARED AND PROVIDED ANOTHER ESTIMATE OF THE COST TO REPAIR ALL OF THE OTHER CLAIMED AREAS OF DAMAGE FALLING OUTSIDE OF THE SCOPE OF COVERED DAMAGE, IF ANY. AMERICAN COASTAL VIOLATED THE MINIMUM STATUTORY REQUIREMENTS OF ALL INSURERS TO PROVIDE PAYMENT OF ALL UNDISPUTED AMOUNTS DUE AND OWING UNDER THE SUBJECT INSURANCE POLICY IN A TIMELY MANNER. AMERICAN COASTAL KNEW AND/OR SHOULD HAVE KNOWN THAT INSURANCE MONIES WERE DUE AND OWING, HOWEVER, AMERICAN COASTAL HAS NOT MADE ANY PAYMENTS TO THE INSURED. AMERICAN COASTAL MADE NO GOOD FAITH ATTEMPT TO ADJUST THE CLAIM PURSUANT TO THE REPLACEMENT COST VALUE COVERAGES OF THE SUBJECT INSURANCE POLICY. AMERICAN COASTAL REFUSED TO ADJUST THE CLAIM BASED UPON THE SAME HIGH QUALITY MATERIALS AND LABOR THAT WAS USED TO BUILD THE PROPERTIES, WITH ALL OF THE ACCOUTERMENTS EXISTING AT THE TIME THE LOSS. AMERICAN COASTAL ALSO FAILED AND REFUSED TO ADJUST THE INSURED'S CLAIM IN A MANNER THAT WOULD ENABLE THEM TO RESTORE THE PROPERTIES TO A PRE-LOSS CONDITION ON A REPLACEMENT COST BASIS, WITH NEW MATERIALS OF LIKE KIND AND QUALITY. IT DID NOT CALCULATE THE COST TO REPAIR OR REPLACE ADJOINING AREAS OF THE PROPERTIES SO THAT BOTH THE REPLACED AREAS AND ADJOINING AREAS OF THE PROPERTIES REASONABLY MATCH IN QUALITY, COLOR AND SIZE. IT DID NOT ESTIMATE THE COST TO REPAIR OR REPLACE ALL PORTIONS OF THE PROPERTIES THAT WOULD BE DAMAGED DURING THE COURSE OF REPAIRS. AMERICAN COASTAL HAS LARGELY IGNORED THE INSURED'S CLAIM SUBMISSIONS. AMERICAN COASTAL HAS ACTED IMPROPERLY AND IN BAD FAITH BY IGNORING OR SUMMARILY DISMISSING THE INSUREDS, AND THEIR CLAIM SUBMISSIONS, WITHOUT CONDUCTING A FAIR AND REASONABLE INVESTIGATION. IN SUM, AMERICAN COASTAL DID NOT INVESTIGATE AND FAIRLY OR REASONABLY INTERPRET THE FACTS SURROUNDING THIS CLAIM. AMERICAN COASTAL HAS FAILED TO ISSUE PAYMENT OF THE UNDISPUTED PORTION OF THE INSURED'S PROPERTY DAMAGE CLAIM WITHIN 90-DAYS, DESPITE THE FACT THAT IT HAD ALL INFORMATION NECESSARY TO CALCULATE THE PAYMENT FOR THE UNDISPUTED PORTION OF THE CLAIM. AMERICAN COASTAL FAILED TO PROMPTLY PAY THE FULL BENEFITS OWED TO THE POLICYHOLDER. THE REASONS FOR THIS MAY BE ATTRIBUTED TO INADEQUATE STAFFING, IMPROPER TRAINING, SUPERVISION, AND/OR FAILURE OF ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY INVESTIGATE, ADJUST AND PAY FULL BENEFITS AVAILABLE TO ALL BENEFICIARIES. THE INSURER FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES, OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. AMERICAN COASTAL HAS FAILED TO CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION TO EVALUATE CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES, RESULTING IN STATUTORY VIOLATIONS AS SET FORTH ABOVE. AMERICAN COASTAL HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE, EVALUATE AND ISSUE PAYMENT ON THE INSURED'S INSURANCE CLAIM AND DAMAGES. AMERICAN COASTAL HAS FAILED AND/OR REFUSED TO ACKNOWLEDGE AND ACT PROMPTLY UPON COMMUNICATION FROM ITS INSURED (OR THEIR REPRESENTATIVES) WITH RESPECT TO THE INSURANCE CLAIMS. AMERICAN COASTAL HAS FAILED TO PROMPTLY SETTLE THE INSURED'S INSURANCE CLAIMS WHEN THE OBLIGATION TO SETTLE THESE CLAIMS HAD BECOME REASONABLY CLEAR, UNDER AT LEAST ONE PORTION OF THE INSURANCE POLICY’S COVERAGES, IN ORDER TO INFLUENCE THE SETTLEMENTS UNDER OTHER PORTIONS OF THE INSURANCE POLICY COVERAGE. TO DATE, NOTWITHSTANDING THE INSURED'S PLEAS OTHERWISE, AMERICAN COASTAL HAS CONTINUED TO REFUSE TO ACKNOWLEDGE ITS OBLIGATION TO TENDER ALL INSURANCE MONIES DUE AND OWING THE INSURED, OR ASSIST THE INSURED IN THE MITIGATION OF THEIR DAMAGES. THE INSURED WAS THEN, AND IS STILL, FORCED TO EXPEND MONIES TO SUBMIT THE INSURANCE CLAIM, PAY FEES AND COSTS, RETAIN EXPERTS TO INVESTIGATE THE FULL EXTENT AND NATURE OF THE LOSS, AND TO FORCE AMERICAN COASTAL TO HONOR ITS OBLIGATIONS UNDER THE INSURANCE POLICY AND PAY ALL THE INSURANCE PROCEEDS DUE AND OWING THE INSURED. THE INSURED HAS DEMANDED THAT AMERICAN COASTAL ACKNOWLEDGE THE CLAIM SUBMISSIONS, AND ISSUE PAYMENT IN FULL. AMERICAN COASTAL REFUSED AND/OR FAILED TO ACKNOWLEDGE THESE CLAIM SUBMISSIONS, TENDER ALL INSURANCE PROCEEDS OWED TO THE INSURED UPON DEMAND, AND UNREASONABLY WITHHELD PAYMENT TO THE INSURED. AMERICAN COASTAL'S REFUSAL AND/OR FAILURE TO SETTLE THE INSURANCE CLAIM WHEN UNDER ALL CIRCUMSTANCES IT COULD HAVE AND SHOULD HAVE DONE SO HAD IT ACTED FAIRLY AND HONESTLY TOWARDS THE INSURED IS UNREASONABLE, WRONGFUL AND ILLEGAL CONDUCT. IN FACT, AMERICAN COASTAL'S REPRESENTATIVES HAVE MADE MATERIAL MISREPRESENTATIONS TO THE INSURED CONCERNING THE STATUS OF ITS INVESTIGATION AND ADJUSTMENT OF THE CLAIM. AMERICAN COASTAL HAS DONE LITTLE MORE THAN MANUFACTURE REASONS FOR DELAY, COVERAGE DEFENSES AND PURSUE EVIDENTIARY SUPPORT FOR PRE-CONCEIVED AND ILL-CONCEIVED COVERAGE DEFENSES, ALL IN BAD FAITH ON THE PART OF AMERICAN COASTAL. IT IS BELIEVED THAT FUTURE BAD FAITH DISCOVERY MAY REVEAL AN EXTENSIVE HISTORY OF DENIALS (OR UNDERPAYMENTS) OF CLAIMS SIMILAR TO THAT OF THE INSURED(S) AND OTHER INSUREDS ACROSS THE STATE OF FLORIDA, AS THIS CONDUCT APPEARS TO BE A BUSINESS PRACTICE OF THIS INSURER. IN FLORIDA THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. AMERICAN COASTAL BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES AS WELL AS THIS TRUST. TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, AMERICAN COASTAL MUST: (1) CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION AND EVALUATION AS TO CLAIMS HANDLING AND FOR THE TRAINING AND SUPERVISION OF EMPLOYEES, AGENTS AND REPRESENTATIVES WHICH WILL AVOID FUTURE STATUTORY VIOLATIONS AS SET FORTH ABOVE TO AVOID THIS FROM OCCURRING IN THE FUTURE. (2) CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR THE PROPER INVESTIGATION AND EVALUATION OF WINDSTORM AND ASSOCIATED WATER DAMAGE CLAIMS, AND FOR THE TRAINING AND SUPERVISION OF EMPLOYEES, AGENTS AND REPRESENTATIVES WITH REGARD TO THESE CLAIMS TO ENSURE THAT AMERICAN COASTAL'S CLAIMS HANDLING PROCEDURES WITH REGARD TO THESE TYPES OF LOSSES ARE ADEQUATE TO STOP UNFAIR AND WRONGFUL TREATMENT OF INSUREDS. (3) ASSIST THE INSUREDS IN MITIGATING DAMAGES. (4) PROMPTLY AND TIMELY RESPOND TO REQUESTS FOR INFORMATION BY INSURED. (5) ACT FAIRLY AND HONESTLY TOWARDS THE INSUREDS AND WITH DUE REGARD FOR THEIR INTERESTS IN ATTEMPTING TO SETTLE THE INSURED'S CLAIM. (6) IMMEDIATELY TENDER ALL INSURANCE MONIES DUE AND OWING THE INSURED PURSUANT TO THE MOST RECENT ESTIMATES AND PROPERTY INVENTORIES. (7) ACKNOWLEDGE IN WRITING TO THE INSURED THAT AMERICAN COASTAL'S HANDLING OF THIS CLAIM IS AND WAS INSUFFICIENT TO PLACE THE INSURED BACK INTO A PRE-LOSS CONDITION. (8) TAKE ANY OTHER REASONABLE AND NECESSARY MEASURES TO PLACE THE INSURED BACK INTO A PRE-LOSS CONDITION. (9) ACKNOWLEDGE, IN WRITING, ITS SINCERE APOLOGY TO THE INSURED FOR ITS WRONGFUL CLAIMS HANDLING PRACTICES IN THE ADJUSTMENT OF THIS CLAIM. (10) IMMEDIATELY PAY ALL UNDISPUTED AMOUNTS CLAIMED PLUS ADDITIONAL LIVING EXPENSES AND INTEREST (BUT SUBTRACT PRIOR PAYMENTS AND DEDUCTIBLE) WHICH AMOUNT(S) IS/ARE EXCLUSIVE ANY CLAIMS FOR FEES, COSTS, BAD FAITH OR EXTRA-CONTRACTUAL DAMAGES.
Comments
User Id Date Added Comment
jstrudwick@camboferry.com 12-23-2024 December 20, 2024 VIA EMAIL ONLY Regency Gardens Condominium Association, Inc. c/o The Woodward Law Firm Attn: Hew Woodward, Esq. P.O. Box 140312 hew@hgwlegal.com; pleadings@hgwlegal.com RE: Date of Loss: 09/28/2022 Insured's name: Regency Gardens Condominium Association, Inc. Carrier Name: American Coastal Insurance Company Claim Number: 4199716 Policy Number: AMC-37034-03 CRN Filing Numbers: 788866, 788867,788868, 788869 Dear Mr. Woodward, As you know, my firm represents American Coastal Insurance Company (“AmCoastal”) with respect to the above matter. This correspondence constitutes AmCoastal’s response to the Civil Remedy Notice of Insurer Violation (“CRN”) with filing numbers 788866, 788867,788868, 788869, you filed on behalf of Regency Gardens Condominium Association, Inc. (“Regency”). The Notice is void because it is legally invalid. Beyond that, the allegations in the Notice have no merit. I. The Civil Remedy Notice is legally invalid. The filing of a valid Civil Remedy Notice is a condition precedent to an action brought pursuant to section 624.155, Florida Statutes. Talat Enter., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Because the statute is in derogation of the common law, it must be strictly construed. Id. “[A]ny statute in derogation of the common law requires strict compliance with its provisions by one seeking to avail himself of its benefits.” Florida Steel Corp. v. Adaptable Devs., Inc., 503 So. 2d 1232, 1234 (Fla. 1986). Section 624.155, Florida Statutes, requires a civil remedy notice to provide specific information to put the AmCoastal on notice of the alleged violation. Additionally, a civil remedy notice must be “specific enough to provide Insurer notice of the wrongdoing so the Insurer can cure the same within sixty days.” Valenti v. Unum Life Ins. Co. of Am., 8:04CV1615T-30TGW, 2006 WL 1627276, at *2 (M.D. Fla. 2006). Here, the Notice is invalid because it does not contain all of the information required by section 624.155. Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Specifically, it fails to contain the Insured’s email address and the insurance company’s address, making the same defective under Fla. Stat. 624.155. See Pin-Pon Corp. v. Landmark Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020) Also, it is invalid because it lacks sufficient specificity to provide notice to AmCoastal of the alleged wrongdoing, as discussed below. First, the Notice is invalid because it does not list a specific cure for the alleged violations and instead generally references changes to guidelines, tendering all insurance monies due and owing [to] the insured pursuant to the most recent estimates and property inventories, and immediately paying all amounts necessary to repair the damage to the properties, plus interest. In Talat, the Florida Supreme Court said that to “cure” a Notice, an Insurer must pay the amount owed pursuant to the express terms and conditions of the policy.” However, no cure amount of any kind is provided, illusory statements are made as to tendering all money and paying all amounts necessary but AmCoastal is left to guess what those amounts are and what would be required to “cure” the alleged violations. It is improper for a civil remedy notice to not contain a cure, therefore the CRN is invalid. Talat, 753 So. 2d at 1282–83; see also Francois v. Illinois Nat. Ins. Co., 01-CV-8070, 2002 WL 33760405, at *4 (S.D. Fla. 2002) aff'd, 49 Fed. Appx. 290 (11th Cir. 2002). Second, the Notice is invalid because it conditions AmCoastal’s ability to “cure” by requiring AmCoastal to pay for things and do things that are not required under Talat. In Talat, the Florida Supreme Court said that to “cure” a Notice, an Insurer must pay the amount owed pursuant to the express terms and conditions of the policy.” However, the Notice here demands payment of money that is not owed pursuant to the policy, such as interest. It is improper to demand such items as a cure for a civil remedy notice. Talat, 753 So. 2d at 1282–83; see also Francois v. Illinois Nat. Ins. Co., 01-CV-8070, 2002 WL 33760405, at *4 (S.D. Fla. 2002) aff'd, 49 Fed. Appx. 290 (11th Cir. 2002) (discussing whether a demand of attorneys’ fees in a civil remedy notice is proper). Third, the boilerplate CRN lacks sufficient specificity to provide notice of the alleged bad-faith conduct. The CRN lists 14 different statutes/subsections which AmCoastal allegedly violated. However, the CRN fails to provide any relevant facts supporting the alleged violations or relating these alleged violations to the 14 cited statutes/subsections. Because the Civil Remedy Notice fails to identify any specific statutes or any facts to support why the Insured believes AmCoastal violated the statutes, AmCoastal is unable to properly respond, and the Notice is invalid and should be rejected and returned. Lastly, the CRN fails to sufficiently allege any specific policy provision which AmCoastal has violated. Instead, it engages in a kitchen sink approach, attaching building policy limits, citing to ordinance and law provisions, deductibles, optional coverages but fails to provide any relation between AmCoastal’s coverage determination and the same. The CRN does not even consider whether the Insured has coverage under some of these option provisions cited. Nonetheless, this approach is categorically insufficient for AmCoastal to determine what portion of the policy the Insured is alleging has been violated and therefore the Notice is invalid and should be rejected and returned. Because the CRN fails to comply with the information requirements promulgated by the Department of Financial Services, it is legally invalid. See Pin-Pon Corp. v. Landmark Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Prop. & Cas. Ins. Co., 4D19-2763 (September 23, 2020); Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Again, in serving this response, AmCoastal reserves all rights under Florida law to be served with a properly completed and statutorily compliant CRN. As the CRN fails to strictly comply with the requirements of section 624.155, Florida Statutes, it is legally insufficient and should be rejected. II. The Civil Remedy Notice Lacks Merit The Notice also lacks merit. AmCoastal issued a commercial policy to the Insured, insuring the various properties located at Thorbriar Lane, Rosebriar Way, Lizshire Lane, Chirshire Way, Perkinshire Lane, and Devonbriar Way, Orlando, FL 32822, for a policy period from September 8, 2022 through September 8, 2023. The insured property is 20 buildings, a clubhouse, and maintenance building for a total of 22 buildings that are insured as follows subject to a 3% Hurricane Deductible: On or about November 8, 2022, AmCoastal received its first notice of loss regarding Hurricane Ian damages. On or about November 19-21 2022, AmCoastal had its Senior Building Consultant from Sedgwick CMS, Bryan Keene, Field Adjuster, Ryan Watson, and Christopher Campbell of Young & Associates inspect the insured property. On or about April 27, 2023, Sedgwick Delegated Authority issued the coverage determination on behalf of AmCoastal resulting in a $587,606.37 RCV estimate, which after the application of the 5% deductible to the buildings which showed damage and resulted in a net undisputed payment of $37,560.32. The coverage determination letter advised as to the reimbursement of any depreciation and consideration for additional payment once the repairs have been made pursuant to the terms and conditions of the policy. Thereafter, Plaintiff presented an SPOL executed by Daniel Henry for $2,390,036.19 and provided an engineer report from Modern Empire Consulting. AmCoastal acknowledged the proof of loss but advised that they did not agree with the amounts contained therein. On June 6, 2024, Helen Singletary from Sedgwick Delegated Authority issued a reservation of rights and request for information advising as to an upcoming engineer inspection and requesting the following material information: 1. Association meeting minutes for the last eight years, to include: 2017 except for May and December, 2018, 2019 and 2020 except for December, 2021 except for February, August, November and December, 2022 except for January, March, June, July, August, October and December, 2023 except for January, October and December. 2. Revised Proof of Loss if necessary, estimates, invoices, receipts, and contracts for work performed or to be performed in relation to the damage reported for this claim not yet provided. To include but not limited to all the siding repairs prior to Hurricane Ian. A revised invoice for Unit C 308 and actual invoice for Building B and C lightning rods removal and replacement. 3. List of interior units with reported damage from this claim, or verification the provide spread sheet is up to date. 4. All internal incident reports, maintenance requests, work orders, etc. relating to the areas being claimed as damaged not yet provided. 5. Any reports, including appraisals, prepared by or on behalf of the Association which speak to the condition of the property prior to the date of loss. 6. Any photographs, videos or otherwise which depict the condition of the property at any time, both before and after the date of the loss; not yet provided. 7. Any other documentation which supports the Association’s contention that the claimed damage was due to a covered cause of loss. On June 19 through June 24, 2024, Keystone Experts and Engineer’s, Scott Crandall, PE and Cole Crandall for Ladder Assist, inspected the property. They found no wind damage as a result of Hurricane Ian and opined as to the various damages witnessed to the shingles ranging from thermal expansion and contraction, improper or defective installation, long term wear, tear, and deterioration and manual manipulation. They also noted numerous areas of prior repairs. On July 15, 2024, Plaintiff’s Public Adjuster from Stone Claims Group provided documentation in response to Sedgwick’s request for information. Of note, some meeting minutes and invoices of costs incurred were provided. These documents showed that the costs incurred did not exceed the amount paid by AmCoastal. On September 24, 2024, Plaintiff’s Counsel filed a Notice of Intent to Litigate no. 211188 pursuant to Fla. Stat. 627.70152. Pursuant to Fla. Stat. 627.70152, AmCoastal has ten (10) business days to respond to Plaintiff’s notice. Instead of complying with the statute, Plaintiff’s Counsel filed suit on September 27, 2024, three (3) days later. Thereafter, said suit was served on the Chief Financial Officer of the State of Florida by electronic delivery on October 30, 2024, just four (4) days after they served a Civil Remedy Notice on AmCoastal and fifty-four (54) days before the expiration of the cure period in violation of Fla. Stat. 624.155. On October 7, 2024, Sedgwick Delegated Authority issued a supplemental payment related to the receipt of a tarping invoice and provided the Insured with a copy of the engineer report. The following day, in compliance with Fla. Stat. 627.70152, the undersigned submitted AmCoastal’s response to the Notice of Intent to Plaintiff’s Counsel which, much like this response, relied upon its coverage determination and referenced the various exclusions of coverage and deficiencies within the Notice of Intent. In response to the four identical CRN’s filed by Plaintiff’s counsel, the undersigned submitted requests for material information relevant to the Insured’s claim and the veracity of their claims of bad faith. Plaintiff’s counsel and the Insured failed to acknowledge, much less reply to, these material and relevant requests, thereby prejudicing AmCoastal’s ability to cure. As stated above, there is no cure amount presented and despite valiant efforts to request the same from counsel they went unanswered. No invoices or cancelled checks have been provided to support any work being performed by the Insured or that would necessitate the return of any recoverable depreciation or additional payment. At the outset, Plaintiff’s representation has placed settlement ahead of a proper investigation of the loss and compliance with both Florida Statutes and the Florida Rules of Civil Procedure. An insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. AmCoastal stands behind its coverage determination but will continue to work with the Insured to ensure an amicable resolution. As outlined above, AmCoastal has abided by the policy and stands by its decision on this claim. As such, AmCoastal has complied with all policy provisions and applicable Florida law regarding the adjudication of this matter. Coverage was properly afforded for the Insured’s loss and payment was issued for covered damages for the subject claim pursuant to the terms, conditions, exclusions, limits, recoverable depreciation, and deductible of the subject policy. Based on the foregoing, AmCoastal agrees that it will continue evaluating this claim and issue any payments for which coverage is confirmed but denies any and all allegations of bad faith in connection with the claim submitted by the Insured and considers this matter cured based upon the allegations within this CRN. If you have any questions, please do not hesitate to contact me. Warmest regards, CAMBO FERRY, PLLC Joshua D. Strudwick, Esq. jstrudwick@camboferry.com
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