Filing Number: 791455
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| Filing Accepted: 11/11/2024 |
| Last/Business Name
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| Street Address
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512 OAKHURST WAY |
| City, State Zip
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LAKE ALFRED,
FL
33850
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| Email Address
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JC@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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SCRUGGS |
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First Name |
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ANDRE |
| Policy # * |
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FLA340419 |
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Claim #* |
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1113258-221001 |
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Attorney is Applicable
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| Last Name* |
CAFARO
First Name *
JOSEPH
Initial
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| Street Address* |
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800 E. BROWARD BLVD., STE. 510 |
| City, State Zip* |
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FORT LAUDERDALE
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FL
33301
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| Email Address * |
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JC@WEKLAW.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 STRATEGIC INSURANCE CORP.
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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 10872 |
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| Name of individual responsible for violation (if any):*
NO NAME KNOWN
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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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Claim Denial
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Claim Delay
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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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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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(2) |
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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.
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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)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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.
PERILS INSURED AGAINST
COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insure against risk of sudden and accidental direct physical loss to property
described in Coverages A and B only if that loss is a physical loss to the
property.
We do not insure, however, for loss:
• • •
3. Excluded under General Exclusions.
Under items 1. and 2. , any ensuing loss to property described in Coverages
A and B not excluded or excepted in this policy is covered.
• • •
GENERAL EXCLUSIONS
1. We do not insure for loss caused directly or indirectly by any of the
following. Such loss is excluded regardless of any other cause or event
contributing concurrently or in any sequence to the loss.
• • •
c. Water Damage, meaning:
1. Flood, surface water, waves, tidal waves, tsunami, tides,
tidal water, overflow of any body of water, or spray from
any of these, whether or not driven by wind or storm
surge;
2. Water, water-borne material, sewage or any other
substance which backs up through sewers or drains or
which overflows or is discharged from a sump, sump
pump or related equipment;
3. Water, water-borne material, sewage or any substance
that overflows from a sump pump, sump pump well or
other system designed for the removal of subsurface
water which is drained from a foundation area of a
structure; or
4. Water, water-borne material, sewage or any other
substance on or below the surface of the ground,
regardless of its source. This includes water which exerts
pressure on or flows, seeps or leaks through a building,
sidewalk, driveway, foundation, swimming pool or other
structure.
This exclusion c. applies regardless of whether any of the
above, in c.(1) through c.(4) is caused by or results from
human or animal forces or by any act of nature.
This exclusion c. applies to, but is not limited to, escape,
overflow or discharge, for any reason of water, waterborne
material from a dam, levee, seawall or any boundary or
containment system.
Direct loss by fire, explosion or theft resulting from water
damage is covered.
• • •
d. Power Failure, meaning the failure of power or other utility service if
the failure takes place off the Described Location. But if the failure of
power or other utility service results in a loss, from a Peril Insured
Against on the Described Location, we will pay for the loss or damage
caused by that Peril Insured Against.
• • •
p. Wind or Hail Damage to:
1. Outdoor radio and television antennas or satellite dishes and
aerials including their lead in wiring, masts or towers; or
2. Awning, fences, aluminum framed screened enclosures,
including pool cages and aluminum framed carports; or
3. All personal property unless it is located within the principal
residence for which this policy applies.
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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.
Andre Scruggs ("Insured") purchased an insurance policy ("Policy") from American Strategic Insurance Company (“ASI”) with effective coverage on the date of loss, on or about September 28, 2022, as a result of Hurricane Ian, and Policy number FLA340419 to insure the property located at 512 Oakhurst Way, Lake Alfred, FL 33850 (the "Property").??
On or about September 28, 2022, the Property suffered severe wind and rain damage as a result of Hurricane Ian, which caused ensuing water damage to the Property, including but not limited to the interior ceilings, walls and floors and roof ("Loss"). Upon discovery of the damages from Hurricane Ian, September 28, 2022, the Insured immediately reported the claim to ASI.
The Insured retained a Public Adjuster, Elevate Claim Adjusters (“Elevate”) to aid with this claim. Elevate inspected the property and determined that it was clear that the loss was a result of Hurricane Ian. ASI acknowledged the claim and assigned the loss claim number 1113258-221001.
A field adjuster was assigned to the claim. The field adjuster inspected the property on October 11, 2022. During his inspection, the field adjuster viewed the interior and exterior of the home and the roof. Additionally Elevate provided ASI with photos of the damage, as well as an estimate in the amount of $50,133.93 to place the home in the pre-loss condition. During the inspection, the field adjuster did an inadequate job of documenting and assessing damages at the Property.
ASI then conducted a reinspection on or about May 23, 2024, at this time finding considerable damage to the roof but finding in a conclusory and self-serving manner that the damage was unrelated to any weather event.
The insured hired Deluge Doctors LLC to perform tarping and water dryout services, as he was concerned that the moisture would lead to mold. ASI has refused to pay these invoices.
On November 10, 2022, ASI issued a coverage determination indicating that they were only opening coverage for the garage ceiling, loft and master closet, dining room baseboards, and external security cameras, they did not believe that the damage the home sustained would exceed the insureds deductible of $6,320.00, therefore no payment was made. ASI further provided a supporting estimate that glossed over the extent and nature of damages. The coverage determination letter itself was intentionally vague and ambiguous as to whether ASI determined that there had been a peril created opening, despite the fact that a category 5 hurricane had just made landfall and impacted the Insured’s home, and the available photographic evidence.
One of the biggest area’s of damage to the home was the roof, and conveniently, ASI, failed to discuss the roof at all in their coverage determination letter. ASI would later claim that they observed no wind damage whatsoever to the insured’s roof.
ASI failed to tender the full amount of monies due and owing under the terms of the policy. To date, notwithstanding the Insureds’ pleas for relief, ASI has continued to refuse to acknowledge its obligation to tender all monies due and owing to the Insured, and to fully assist the Insured in the mitigation of his damages. The Insured timely notified ASI of the damages and opened a claim pursuant to the terms and conditions of the insurance policy. In response to their claim for benefits, ASI sent a representative to investigate and adjust the loss. The adjuster for ASI confirmed that there were damages to the property. Despite recognizing the presence of damage to the property, ASI and its representatives attempted to settle the claim for far less than was owed. ASI misrepresented to the Insureds that it had performed a full and fair investigation and adjustment of the claim at that time and misrepresented that the amounts offered were the full value of the indemnity owed under the provisions of the insurance policy. These misrepresentations were either intentional, or the result of ASI failing to adequately train and supervise its adjusters and representatives.
The carrier needs to be held accountable for this unilateral and unreasonable delay. ASI has violated Florida Statute §624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its insured. ASI has also violated Florida Statute §624.155(1)(b)(3) by failing to promptly settle this covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property. ASI violated Florida Statutes §626.9541(1)(i)(2) and §626.9541(1)(i)(3)(b) by making material misrepresentations to the Insureds for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy.
ASI was informed multiple times of the discrepancies and inconsistencies of the below value payment issued to the Insureds. While ASI was made aware of this information for the purpose of obtaining the money contractually owed to the Insureds under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, ASI has refused to do so and has delayed properly adjusting this claim.
ASI violated §626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation in this case. ASI and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insureds. After being placed on notice as to the blatant underpayment of the Insureds’ claim, ASI has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed.
ASI violated §626.9541(1)(i)(3)(g) by failing to promptly notify the Insureds of any additional information necessary for processing the claim. The Insured has more than complied with each and every request and there has still been no action by ASI. In the event ASI is in need of additional information, they have failed to promptly notify the Insureds in a timely manner. This pattern of behavior is perpetuated by ASI and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the insured throughout the insurance claim process.
Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from ASI approaching the investigation and settlement in a manner prejudicial to the Insureds, failing to allow a fair settlement with the Insureds, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insureds were not afforded the professional duties entrusted on ASI by the public.
To date, ASI has failed to adequately compensate the Insured for the damage that occurred on September 28, 2022, despite having months to pay the Insureds’ claim in full. As a direct result of ASI’s delay, the Insured was forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that ASI knowingly and intentionally are delaying the claims process in order to further disadvantage the Insureds. The financial detriment caused to the Insured and his tenants is a direct result of ASI’s reckless delay of the claim process.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should ASI fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, ASI must: (1) Immediately tender the $78,484.18, due and owing to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.
Additionally, during litigation ASI has attempted to further leverage the insured to pay for its own litigation-related costs. The parties had mutually coordinated to have a litigation inspection performed by the carrier occur on November 12, 2024. ASI knew or should have known that there was a tarp on the roof. ASI knew or should have known that it was their responsibility to pay for the removal and replacement of the tarp, and that the insured was not responsible for paying that amount out of their own pocket. Late in the day on November 11, 2024, ASI indicated that it would refuse to conduct the inspection, despite the insured and the tarp company all having made commitments to have the inspection proceed, if the insured themselves did not pay for the tarp’s removal and replacement so that the carrier’s expert could inspect the property.
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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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