Filing Number: 791072
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| Filing Accepted: 11/8/2024 |
| Last/Business Name
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NGUYEN
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First Name |
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THANH HUNG |
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| Street Address
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2421 LAUDERDALE COURT |
| City, State Zip
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ORLANDO,
FL
32805
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| Email Address
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JENUINE2017@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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NGUYEN |
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First Name |
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THANH HUNG |
| Policy # * |
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AGD10451771 |
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Claim #* |
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CDP-00172012 |
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Attorney is Applicable
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| Last Name* |
BRAZ
First Name *
TAMARA
Initial
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| Street Address* |
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8865 COMMODITY CIR. STE. 12 |
| City, State Zip* |
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ORLANDO
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FL
32819
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| Email Address * |
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TBRAZ@THELAWGICALFIRM.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 12841 |
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| Name of individual responsible for violation (if any):*
? SEAN T. WOODAND, FIELD ADJUSTER ON BEHALF OF AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA;
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unfair Trade Practice
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Other
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Improper Investigation
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
POLICY FORM: DP 00 01 07 88
COVERAGES
***
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[;]
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CONDITIONS
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4. Your Duties After Loss. In case of a loss to
covered property, you must see that the following are done:
a. give prompt notice to us or our agent[;]
***
d. as often as we reasonably require:
(1) show the damaged property;
(2) provide us with records and documents we request and permit us to make
copies[;]
***
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
On or about January 9, 2024, Thanh Hung Nguyen (Complainant(s)) suffered a loss to their Property, located at the address listed above. After discovering the damage, Complainant(s) reported the loss to American Integrity Insurance Company of Florida (“Insurer”) on or about March 14, 2024.
Throughout the Insurer’s investigation, Complainant(s) has fully cooperated with the Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant(s) custody, possession and control.
The Insurer, however, has failed to fulfill its duties under the Policy and Florida law by not providing a fair evaluation of the claim.
Claim Facts:
On or about March 13, 2024, Complainant retained and contracted with Serene Adjusters to act as their Public Adjuster (hereinafter referred to as ‘PA’).
On or about March 14, 2024, the PA sent a letter of representation to the Insurer.
Subsequently, on the same day, the Insurer responded to the representation and reporting of the claim, which included a Reservation of Rights letter, a claim acknowledgment letter, and the Homeowner Bill of Rights.
On or about March 25, 2024, a field adjuster, Sean T. Woodand (hereinafter referred to as "FA"), conducted an inspection of the property and took photographs.
On the same day as the inspection, the Insurer issued a coverage determination letter. The issuance of this letter on the very day of the inspection raises concerns about the thoroughness of the investigation conducted by the Insurer.
In the coverage determination letter, the Insurer stated observations including: “Wear and tear, deterioration, and granular loss to the roof shingles." and “Age-related blistering and loss of granules."
The Insurer's decision to rely solely on the FA’s observations as the basis for determining causation in the claim coverage was improper and insufficient. The FA's primary role is to assess and document visible damages, not to determine the underlying cause of those damages—especially when causation involves complex factors such as distinguishing between normal wear and tear, material fatigue, and damage resulting from covered perils like storms or wind-related events.
Determining causation often requires specialized knowledge and expertise that goes beyond the scope of a field adjuster's qualifications. Here, the observations were limited and lacked the technical expertise necessary to make definitive conclusions about causation.
During a single inspection of the property, the FA identified issues such as "wear and tear, deterioration, and granular loss to the roof shingles" and "age-related blistering and loss of granules." However, determining the underlying cause of these conditions requires expert analysis by qualified personnel who can conduct thorough evaluations.
Such assessments involve more than a cursory visual inspection; they necessitate comprehensive testing, detailed analysis, and ample time to investigate all potential factors contributing to the damage. Therefore, relying solely on the FA's observations—without engaging a qualified expert or allowing sufficient time for a proper investigation—is insufficient to conclusively deny coverage.
Furthermore, the haste with which the Insurer issued the coverage determination letter—on the very same day as the FA's inspection—further underscores the inadequacy of the investigation.
The Insurer's decision to close the claim on the same day as the FA’s investigation—merely 11 days after the claim was reported—without sufficient evidence or allowing ample time to conduct even the minimal requirements for a proper claim investigation, suggests that the Insurer was more focused on promptly closing the claim rather than ensuring a fair and accurate assessment of the damage.
Such an improper investigation demonstrates a failure to conduct a proper and thorough investigation as required under Fla. Stat. 626.9541(1)(i)(3)(a).
On the same day, the PA conducted an inspection of the property and took photographs.
On or about March 26, 2024, the PA submitted a comprehensive and detailed estimate of damages to the Insurer, totaling approximately $68,917.43. This estimate included additional photographs and supporting documentation from the PA’s inspection, detailed insights into the extent of the property damage.
The Insurer acknowledged receipt of this new estimate. However, within 24 hours, the Insurer sent email correspondence stating that it still stands by its original decision to deny coverage.
Despite being presented with this new and substantive evidence, the Insurer refused to initiate a new inspection or reconsider its initial determination. Insurer wholly failed to even properly review the information in their possession.
Instead, the Insurer maintained its denial without addressing the new findings or allowing for any further investigation. Upon information and belief, Insurer only seeks to intentionally deny rightful remedies owed to Complainant.
By failing to perform a follow-up inspection or adequately weigh the newly presented evidence, the Insurer did not meet its obligation to thoroughly investigate the claim. Such actions fall short of the requirements set forth under Fla. Stat. 626.9541(1)(i)(3)(d), which obligates insurers to conduct a reasonable investigation based on all available information before denying a claim.
The failure to take the new estimate into proper consideration, and the decision to deny the claim without conducting any further inspection, exemplifies the Insurer’s failure to meet these statutory obligations.
On or about April 15, 2024, the Insurer sent a follow-up email once again denying the claim. By this time, the Insurer had ample opportunity to conduct a more thorough investigation or retain an expert to evaluate the damages and determine causation.
However, despite this reasonable timeframe, the Insurer continued to deny the claim without conducting any further investigation or engaging an expert to provide a proper assessment.
The Complainant retained the Lawgical for legal representation on or about May 7, 2024.
To date, the Insurer has not taken any further investigative steps or engaged an expert to assess the damages, continuing to deny the claim without proper evaluation.
Based on the events described above, the Insurer's inadequate investigation and premature coverage determination deprived the Complainant of a fair evaluation of their claim. The failure to properly investigate could result in the Complainant not receiving the full benefits to which they are entitled under the insurance policy. These tactics are believed to be the general business practices of this Insurer.
Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $66,450.52, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy.
PLEASE GOVERN YOURSELF ACCORDINGLY.
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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