Civil Remedy Notice of Insurer Violations
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Filing Number:     792675
Filing Accepted:  11/15/2024
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Complainant
Last/Business Name *  
METZKER   First Name   DEBRA
Street Address * 10317 SANDRIFT AVENUE
City, State Zip * ENGLEWOOD, FL 34224
Email Address * JCQ@QLAWGROUP.LAW
Complainant Type: * Insured
Insured
Last/Business Name*   METZKER   First Name   DEBRA
Policy # * AGD10080107 Claim #* CDP00131007
Attorney
Attorney is Applicable
Last Name* QUINTANA First Name * J.C. Initial
Street Address* 2665 S. BAYSHORE DRIVE, SUITE 220
City, State Zip* COCONUT GROVE , FLORIDA 33133
Email Address * JCQ@QLAWGROUP.LAW
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):* ASHLEY KEMPS, RYAN WRIGHT, SADIE THURMAN, ATHENA RAIS SMITH, CODY HAYWORTH, ROBERT HICKS,
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)(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)(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)(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.

Based on information and belief, the entire Policy is relevant to the foregoing violations. More specifically, the Loss Settlement Provision has been violated by Carrier.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

American Integrity Insurance Company of Florida (hereinafter, the “Carrier”) has not attempted in good faith to settle the Insureds, Debra Metzker and James Metzker (hereinafter, the “Claimants”) claim for Hurricane Ian damages when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward Claimants and with due regard for their interests. The Carrier has done everything possible to delay the claim and deprive Claimants from benefits due and owed under the policy of insurance. Furthermore, Carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). On September 28, 2022, Hurricane Ian slammed into Florida’s southwest coast as one of the most powerful storms in US history. The storm was just short of being classified as a category 5 hurricane with sustained wind speeds of up to 155mph – 7mph slower than a Category 5. Data evidenced gusts across Florida of 140mph in Cape Coral, 135mph in Punta Gorda, 112mph in Pelican Bay and 110mph in La Belle. Carrier was immediately put on notice of the Claimants’ Hurricane Ian damage on September 28, 2022. Claimants’ obtained and produced to Carrier an estimate reflecting the cost to restore the insured property back to its pre-loss condition. In support of the damages claimed, Claimants produced a photo report documenting substantial and widespread damage to the roof, exterior elevations, garage screen door, pool, and elevated levels of moisture within the exterior walls and interior flooring as a direct and proximate result of a tree falling on the roof of the insured property. Despite Carrier’s own field adjuster, Ryan Wright, who upon information and belief may not have been licensed at the time of his assignment, documenting widespread damage to the roof, fascia, soffits, decorative shutters, gutters, covered lanai, pool enclosure, pool, pool equipment, HVAC and ensuing water damage throughout the interiors as a result of Hurricane Ian, the Carrier only considered and adjusted for a portion of the claimed, observed and documented damages, without asserting any basis to exclude or limit coverage under the policy. Throughout the claim’s handling process, Claimants and their representatives, corresponded with and followed up with the Carrier multiple times regarding the status of the claim, and reconsideration of the damages as adjusted. Ultimately, Carrier has failed and refused to comply with said requests in clear violation of Florida Statute § 627.4137. Nevertheless, on December 22, 2023 – 85 days after the first notice of loss – Carrier acknowledged coverage for the loss, and informed Claimants that payment would be forthcoming in the amount of $0.00. Notably, Carrier’s coverage position letter failed to reference any limiting or exclusionary provisions of the Policy which would apply, nor the applicable deductible of $11,850.00, despite conceding to $19,998.27, in covered repairs. Additionally, despite inspecting the insured property on October 5, 2022, Defendant intentionally refused to complete an estimate of repairs until December 16, 2022. Once the estimate was completed, it failed to consider all of the documented damages to the interiors, gutters, covered lanai, pool, pool equipment, HVAC, and interior of the property. Moreover, the estimate failed to consider items required for the replacement of the roof pursuant to Florida Building Code. At all times material to the subject claim, Carrier has misrepresented pertinent facts concerning the investigation and insurance policy provisions relating to coverages in order to refuse Claimants’ the full benefits due and owed under the subject policy of insurance. Accordingly, Carrier has failed and refused to attempt in good faith to settle the subject claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. Claimants have complied with all Carrier’s requests to date. Notwithstanding, Carrier – based on own unilaterally determined deficient valuation of the claim – has refused to reconsider its adjustment of Claimants’ irrefutable Hurricane Ian damage. Over 779 days have passed since the original date of loss, and Carrier has still refused to pay the fully covered amount owed under the policy. Due to Carriers’ refusal to make sufficient payments as due and owed to Claimants under the Policy necessary to restore the insured property to its pre-loss condition, Claimants have been left with no other recourse than to seek legal recourse against Carrier for its breach of the policy and violations of Florida law. Carrier is well aware of the full extent of the loss and has not taken any meaningful ensuing action since issuing its woefully deficient coverage determination to Claimants. It is clear that Carrier is: (i) not treating the Claimants with good faith claims conduct; (ii) failing to pay a claim clearly owed; (iii) not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to Claimants; (iv) failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the Claimants’ interests; (v) not training, supervising or managing adjusters properly so that prompt and full payments are made; (vi) refusing to pay the full amount owed to the insureds despite the fact that the damages are covered under the policy; (vii) looking for ways to delay full recovery or any recovery to the insureds; and (viii) refusing to provide coverage for the claimant’s loss in a timely manner. Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), and 626.9541(1)(i)(3)(d). Carrier’s conduct is not isolated, but appears to be an intentional pattern and business practice adopted in the handling of its claims, as experienced by the undersigned counsel’s clients in several other claims presented to Carrier. Therefore, to cure the defects outlined in this Civil Remedy Notice, Carrier must: 1) pay the complete covered loss in the amount of $107,149.19, less the applicable policy deductible; 2) pay the Claimants’ attorneys’ fees and costs as they have been forced to retain counsel; 3) pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; 4) implement proper standards for the adjustment and investigation of claims; and 5) placing the interests of its insureds before Carrier’s own interests. A copy of this letter and filed form submitted to the FDFS has been printed out and mailed. Please do not hesitate to contact the undersigned at (305) 419-4090 if you have any questions or concerns.
Comments
User Id Date Added Comment
jwank@kelleykronenberg.com 12-11-2024 To Whom It May Concern: This is American Integrity Insurance Company of Florida’s (American Integrity) formal response to the Civil Remedy Notice of Insurer Violations (CRN) filed on behalf of James and Debra Metzker (Insureds), by J.C. Quintana, Esq., as it relates to Claim Number CDP-00131007. The Department of Financial Services (DFS) accepted the CRN on November 15, 2024, and assigned it filing number 792675. After reviewing the CRN, American Integrity denies all allegations contained therein. American Integrity conducted a thorough review of its handling of the Insured’s claim at issue and referenced above. American Integrity denies that it has violated any of the statutes as alleged in the CRN. At all times, American Integrity acted in good faith, fairly, and honestly toward the Insureds and with due regard for the Insureds’ interests. American Integrity also asserts that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information to allow American Integrity to correct any alleged violations. The CRN requires the Insured to “indicate all statutory provisions alleged to have been violated," pursuant to section 624.155, F.S. The notice filed by J.C. Quintana, Esq., in the above-referenced matter includes statutory provisions that could be claimed against an insurance company regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the CRN fails to identify the specific facts applicable to the listed statutes that were allegedly violated with respect to the subject claim, American Integrity is unable to properly respond and said CRN should be rejected and returned. Specifically, the Insureds allege the following violations of Florida Statutes: • § 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 and his interests. American Integrity strictly denies any violation of any section of Florida Statute § 624.155(1)(b)(1). • § 624.155(1)(b)(3): Except as to liability coverage, 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. American Integrity strictly denies any violation of any section of Florida Statute § 624.155(1)(b)(3). • § 626.9541(1) (i) (3) (a): Failing to adopt and implement standards for the proper investigation of claims. American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (a). • § 626.9541(1) (i) (3) (b): Misrepresenting pertinent facts or insurance policy provisions relating to coverage at issues. American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (b). • § 626.9541(1) (i) (3) (c): Failing to acknowledge and act promptly upon communications with respect to claims. American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (c). • § 626.9541(1) (i) (3) (e): 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. American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (e). • § 626.9541(1) (i) (3) (f): 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. American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (f). • § 626.9541(1) (i) (3) (g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (g). • § 626.9541(1) (i) (3) (h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (h). • § 626.9541(1) (i) (4) : Failing to pay undisputed amount of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer received notice of a residential property insurance claim, determines the amount of partial or full benefits, and agreed to coverage, unless payment of the undisputed benefits is prevents by factors beyond the control of the insured as defined in s. 627.70131(5). American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (4). • § 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; American Integrity strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (j). Also, the CRN fails to set forth any specific policy language alleged to have been violated in accordance with Florida Statute §624.155(3)(b)(4). Instead, Insureds’ CRN contains a list of the headings of sections common to all policies, without any indication of the actual language at issue. Florida courts have determined that improperly providing the “specific policy language” relevant to the allegations in the CRN renders the CRN ineffective in fulfilling the requirements of bringing an action under Florida Statute §624.155. See Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported, vague, ambiguous, and incorrect allegations with no apparent basis in fact. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit, and American Integrity denies each and every one. American Integrity denies the alleged violation that it acted intentionally or with reckless disregard of the rights and needs of the Insureds, and that it failed to act in good faith and failed to comply with the terms and conditions of the subject policy of insurance. To the contrary, American Fidelity promptly investigated the claim in accordance with the Policy’s terms, conditions, limitations, and exclusions. Additionally, after the Insureds filed suit, a settlement was reached with the Insureds and their attorney. The settlement agreement calls for the Insureds to execute a full and final release and hold harmless in favor of American Integrity, as well as file a stipulation of dismissal with prejudice of all claims. As such, the issues raised in the CRN have been resolved. American Integrity’s actions in handling the Insureds’ claim were prompt, thorough, conducted in accordance with the Policy and Florida law, and most importantly, in good faith. Throughout the handling of the Insureds’ insurance claim, American Integrity has adjusted the loss in accordance with the policy provisions and standard claims handling practices. American Integrity therefore takes exception to any allegations to the contrary. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very truly yours, /s/ Noah C. Nite Noah C. Nite, Esquire
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