Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 792104

Filing Accepted: 11/13/2024

Print Filing

Complainant

Last/Business Name *

RANDLETT

First Name

DOUGLASS

Street Address *

13839 CAYWOOD POND DR

City, State Zip *

WINDERMERE, FL 34786

Email Address *

LHAMILTON@ITSABOUTJUSTICE.LAW

Complainant Type: *

Insured

Last/Business Name*		RANDLETT		First Name		DOUGLASS
Policy # *		FLP278115		Claim #*		1389596-241013

Attorney

Attorney is Applicable

Last Name*	HAMILTON First Name * LASHANA Initial
Street Address*		350 NORTH LAKE DESTINY ROAD, APT. 106
City, State Zip*		MAITLAND , FL 32751
Email Address *		LHAMILTON@ITSABOUTJUSTICE.LAW

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		ASI PREFERRED INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 13142

Name of individual responsible for violation (if any):* N/A
Type of Insurance * Residential Property & Casualty

Reason for Notice *

Claim Denial

* 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)(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)(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.

The following policy provisions are relevant to this civil remedy notice. Section 1 - Property Coverages – Coverage A – Dwelling Section 1 – Perils Insured Against – Coverage A-Dwelling and Coverage B-Other Structures Section 1- Conditions – 3. Loss Settlement Section 1 – Conditions – 10. Loss Payment

* 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, the Insured, Douglass Randlett, suffered damage to his home located at 13839 Caywood Pond Dr. Windermere, FL 34786 as a result of a severe storm event. Prior to the loss, ASI Preferred Insurance Corp. (“ASI”), had issued a policy of insurance (Policy No.: FLP278115) for the Insured’s property. Said policy, which was issued prior to the loss, was in full force and effect and afforded coverage for damage caused by the storm. ASI was timely notified of the loss by the Insureds and assigned claim number 1389596-241013. During the course of ASI’s investigation, the Insureds made their property available for inspection, provided facts and information surrounding the loss, and complied with ASI’s adjustment of the claim. Despite fully cooperating with ASI’s investigation, ASI inexplicably denied coverage for the roof portion of the Insured’s insurance claim even though there was clear evidence of storm damage to covered property. ASI issued its claims decision letter on August 5, 2024, denying coverage for the roof of the claim and concluding that the ensuing water damages were covered in an amount less than the insured’s deductible. ASI’s claims decision letter also states that prior roof repairs were observed at the subject property. fBoth assertions are inaccurate. The insured has owned this property since it was constructed in 2004 and there have been no prior repairs on the roof. Additionally, and most concerning, ASI’s claims decision letter dated August 5, 2024 goes on to state that ASI inspected the subject property on July 12, 2024 and August 21, 2024 and those inspections revealed no storm damage to the insured’s roof. It is illogical that the date of the letter predates the date of the second inspection, however, information from the second inspection was relied on by ASI in rendering its coverage determination for this claim. This is clear evidence that ASI came to its coverage determination by ignoring relevant facts and information provided by the Insureds and their contractors that established the damage to the roof and interior of the residence was unquestionably the result of a covered storm loss. Most concerning, ASI and its representatives downplayed and misrepresented the findings from its own inspections to avoid tendering payment on a claim that is otherwise covered pursuant to the terms of the policy. ASI intentionally omitted key facts from its coverage decision and attributed all of the damage to excluded perils under the policy with no supporting evidence as to how or when such damages could have otherwise occurred. It is clear that ASI has not acted honestly or fairly towards its Insureds. ASI and its representatives have failed to conduct a proper investigation of the loss, misrepresented the cause and scope of damages at the residence, and misapplied exclusions in the policy in order to wrongfully deny coverage for the Insured’s claim. It has become a general business practice of ASI to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for ASI to arbitrarily deny claims without conducting reasonable investigations based upon information and evidence available to it. In order to cure this civil remedy notice, ASI must acknowledge in writing that the Insureds’ property was damaged by a storm event and that replacement of the roof is covered by the policy. ASI must also tender the undisputed benefits owed to replace the roof and interiors pursuant to the terms of the policy. The written acknowledgement and payment should be issued to the Insureds’ counsel, Lashana Hamilton, Esq., at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.

Comments

User Id		Date Added		Comment
darryl_j_roles@progressive.com		11-22-2024		While ASI Preferred Insurance Corp believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the notice in writing to Cohen Law Group, on November 22, 2024.

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