Civil Remedy Notice of Insurer Violations
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Filing Number:     790438
Filing Accepted:  11/6/2024
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Complainant
Last/Business Name *  
KISELA   First Name   JOHN
Street Address * 3114 FL-70
City, State Zip * ARCADIA, FL 34266
Email Address * ANDYKISELA@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   KISELA   First Name   JOHN
Policy # * AGH0247689 Claim #* CHO-00150329
Attorney
Attorney is Applicable
Last Name* SPAIN First Name * DAVID Initial
Street Address* 20 N ORANGE AVENUE SUITE 1600
City, State Zip* ORLANDO , FLORIDA 32801
Email Address * MMARSHALL@FORTHEPEOPLE.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):* JOSH GRAY, CHASTITY KIDD, MELISSA BRUMBAUGH
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.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – LOSSES INSURED COVERAGE A – DWELLING We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. Loss Settlement (Entire Section)
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about September 28, 2022, Insured’s property was damaged as a result of Hurricane Ian. Upon learning of the damage, Insured promptly reported a claim for damage to Insurer. Insurer investigated the claim, inspected the property on October 21,2022, and rendered an erroneous claims decision. As a result of Insurer’s insufficient payment, Insured provided Insurer with notice to re-open and/or supplement the claim and a copy of an itemized supporting estimate of damages and photographs. Insured also advised of its amenability to attend a pre-suit DFS Mediation. Bad faith discovery will likely reveal that it is a business practice of Insurer to treat insureds who are unrepresented at the time of making a claim, or through the initial claim adjustment process, unfairly. Those insureds regularly receive a calculated denial of the claim and/or low ball offers until after counsel is retained on the insured’s behalf. “[D]amages recoverable in a first- party bad faith suit under section §624.155, Florida Statutes (1989), are those damages which are the natural, proximate, probable, or direct consequence of the insurer's bad faith actions.” Adams v. Fidelity and Cas. Co. of New York, 591 So.2d 929, 930 (Fla. 1992). ? “[E]xcess judgment ... is not the sole measure of damages in bad faith cases [–e.g.,] punitive damages, attorney fees and other direct consequential damages may be recoverable in appropriate cases.” Dunn v. National Sec. Fire and Cas. Co., 631 So.2d 1103, 1106 (Fla. 5DCA 1993). ? “The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer.” §624.155(8), Florida Statutes (2019). ? “The statute [§624.155] also provides for fees as a form of damages. See § 624.155(8) (‘The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer.’ ” Milling v. Travelers Home and Marine Insurance Company, 311 So.3d 289, 292 (Fla. 2DCA 2020). Further, Bad faith discovery will also likely reveal Insurer has a team of individuals it pays to conduct inspections and prepare reports and estimates that attempt to deny claims, and limit or minimize coverage for the insured’s loss. Insurer’s reliance on these estimates and reports benefits the Insurer as they are biased by not addressing the full scope or cost of the loss and the appropriate coverage. According to Department of Financial Services website, as of the date of this filing, 9474 Civil Remedy Notices have been filed against Insurer. To cure this violation, insurer should agree, in writing, to completely bring the property to its pre-loss condition pursuant to the damage estimate attached to the insureds’ Statutory Supplemental Claim Letter, subject to the terms and conditions of the policy of insurance and applicable Florida law. As a result, if the Insurer pays the damages alleged herein, any further claims for additional insurance proceeds will be submitted to the Insurer pursuant to the policy's loss settlement provision. This payment is exclusive of Insured’s claims for statutory attorney fees, costs, and interest pursuant to Florida law. This matter and Insurer’s business practices with respect to loss adjustment and claims handling should be investigated further by the Office of the Insurance Consumer Advocate.
Comments
User Id Date Added Comment
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 David Spain, Esq. 20 North Orange Avenue Suite 1600 Orlando, Florida 32801 MMarshall@ForThePeople.com Re: DFS File No: 790438 Complainant: John Kisela Insured: John Kisela Policy No: AGH0247689 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00150329 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by David Spain, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on November 6, 2024 and assigned it DFS File No. of 790438. 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, John Kisela. 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: David Spain, Esq. via email at: MMarshall@ForThePeople.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