Civil Remedy Notice of Insurer Violations
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Filing Number:     793172
Filing Accepted:  11/19/2024
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Complainant
Last/Business Name *  
RAZA   First Name   KHALIQ AND LILY
Street Address * 27806 COBALT LANE
City, State Zip * WESLEY CHAPEL, FL 33544
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   RAZA   First Name   KHALIQ AND LILY
Policy # * FLP601397 Claim #* 1435721-241013
Attorney
Attorney is Applicable
Last Name* BURKE First Name * RYAN Initial S
Street Address* 575 SECOND AVENUE SOUTH, SUITE 201
City, State Zip* SAINT PETERSBURG , FLORIDA 33701
Email Address * PLEADINGS@DICUSBURKELAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   ASI PREFERRED INSURANCE CORP.
NAIC Company Code 13142
 
Name of individual responsible for violation (if any):* UNKNOWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Unreasonable investigation
Other : Making material misrepresentations to the insured
Other : Misrepresenting insurance policy provisions to the insured
Other : Misconduct toward insured
* 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* 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 - PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure for sudden and accidental direct loss to property described in Coverages A and B Only if that loss is a physical loss to property. SECTION I - CONDITIONS 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.

PURSUANT TO SECTION 624.155, F.S. please indicate all statutory provisions alleged to have been 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims. 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 69O-220.201(4)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition thereof. __________________________________________________________________________________________________________________________________________________________________________________ FACTS OF THE CASE: ASI Preferred Insurance Corp. (“ASI”) committed the following in the handling of the Insured’s claim: 1) failing to pay benefits owed; 2) failure to act in due diligence and good faith to resolve claims; 3) placing the financial interest of the insurer before that of the policy holder; 4) failure to properly train, evaluate, and manage adjusters retained to represent the policies and procedures of ASI; 5) looking for ways to delay the proper handling of the insured’s claim; 6) looking for ways to deny the Insured’s claim; 7) looking for ways to reduce recovery to the Insured; 8) performing an inadequate investigation; 9) Failing to promptly pay the full benefit owed to the Insureds; 10) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; and 11) making a material misrepresentation 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. The reasons for this may be attributed to improper training, supervision, and/or motivation of outside adjusters and claims supervisors to promptly and fairly adjust and pay full benefits available to the Insured. The Insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because a proper investigation and full and prompt payment for the loss is not occurring. Despite the Insured’s timely notification to ASI of the insurance claim, ASI then delayed paying or tendering to the Insured all proceeds due and owing under the subject policy of insurance. Despite the Insured’s pleas otherwise, ASI has failed to acknowledge its obligations under the subject policy of insurance and tender the coverage the Insured is contractually owed and has implemented an arsenal of delay tactics. Historically, Mr. and Mrs. Raza have taken excellent care of maintaining their home, which they value as their most significant asset. To that end, the Insureds, through ASI, insured the property, so that in the event of catastrophe, this precious asset would be protected, and restored to its pre-catastrophe condition. In exchange for premiums paid, ASI renewed a policy of insurance on subject property. Unfortunately, catastrophe struck during this policy period. Hurricane Milton will go down in history as part of the most damaging hurricane seasons to ever impact Floridians. This storm first made landfall near Siesta Key, Florida on Wednesday, October 9, 2024, around 8:30 p.m., as a Category 3 storm with sustained wind speeds of 120mph. According to the National Hurricane Center, with Category 3 Hurricanes “devastating damage will occur”. Category 3 Hurricanes are considered Major Hurricanes where “Well-built framed homes may incur major damage or removal of roof decking and gable ends. Many trees will be snapped or uprooted, blocking numerous roads. Electricity and water will be unavailable for serval days to weeks after the storm passes. Furthermore, the Saffir-Simpson Hurricane Wind Scale (updated May 2021) states “There is a high risk of injury or death to people, livestock, and pets due to flying and falling debris. Nearly all older (pre-1994) manufactured homes will be destroyed. Most newer manufactured homes will sustain severe damage with the potential for complete roof failure and wall collapse. Poorly constructed frame homes can be destroyed by the removal of the roof and exterior walls. Unprotected windows will be broken by flying debris. Well-built frame homes can experience major damage involving the removal of roof decking and gable ends. There will be a high percentage of roof covering and siding damage to apartment buildings and industrial buildings. Isolated structural damage to wood or steel framing can occur. Complete failure of older metal buildings is possible, and older unreinforced masonry buildings can collapse.” Hurricane Milton’s high velocity winds carried massive quantities of rainwater in suspension and drove it into building envelopes, wetting all building materials that encountered the air stream. Moreover, the stress and pressures from these winds cause movement of buildings, and damage to surfaces, joints, gaskets, and sealants that would otherwise perform adequately during a typical rainstorm. The Raza property located at 27806 Cobalt Lane, Wesley Chapel, FL 33544, like thousands of other homes suffered significant open and obvious damage to the roof during Hurricane Milton. As soon as practical following the impact, Mr. Raza reported the loss to ASI. Unfortunately, ASI failed to adequately investigate the claim, or otherwise failed to properly supervise, train, or motivate their field adjuster, failed to engage any qualified professionals to evaluate the open and obvious damage to the home, and as a result, relied upon a grossly deficient estimate of the covered loss and failed to engage a professional necessary to determine the full scope of damage and necessary repair. These wrongful acts forced Mr. and Mrs. Raza to seek legal counsel and, on their own, engage a professional to assess the true scope of the damage and full costs of repair. On October 24, 2024, ASI sent correspondence to Mr. and Mrs. Raza wherein ASI stated “ our investigation found covered damages to your dwelling roof.” The letter however continues, “Based on our review, the repair or replacement cost of the covered portions of the loss came to $2,469.91 which is below the Hurricane deductible of $17,320. For this reason, we will be unable to issue payment for your covered damages.” ASI clearly did not fully incorporate all damages present at the property. To inform ASI of the full scope of damage, Mr. and Mrs. Raza provide photos documentation of the roof damage. On November 8, 2024, ASI in response to the additional photographs, sends correspondence to Mr. and Mrs. Raza stating” Thank you for providing the additional photos for review. After thoroughly examining the images, I must reaffirm our original position. The photos do not appear to show any damage that was not initially accounted for, and it roof appears to be repairable.” To date, Mr. and Mrs. Raza have complied in good faith with all of ASI’s requirements under the subject policy of insurance and the Florida Statutes, and it is only fair that ASI do the same. The Insured feels that the home is their most precious asset. The Insured purchased insurance coverage through ASI to protect the property and paid insurance premiums for years leading up to this catastrophe. Despite paying insurance premiums, reporting the loss timely, and complying with all other policy provisions, ASI has failed to properly adjust the claim, delayed, wrongfully denied insurance benefits, made material misrepresentations regarding material facts and coverages. Fla. Stat. s. 624.02 defines insurance as a contract whereby one undertakes to indemnify another or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate their damages and put the home back to the condition it was in prior to the loss as quickly as possible; ASI clearly breached this duty. The actions taken by ASI in the mishandling of the Insured’s claim were willful, wanton, and in complete disregard of the rights of its Insured and occurred with such a frequency in this case as to indicate a general business practice and are in violation of Fla. Stat. §§ 624.155 and 626.9541. ASI’s actions amount to but are not limited to the following: 1. CLAIM DELAY 2. UNSATISFACTORY SETTLEMENT OFFER 3. FAILING TO CONDUCT A PROPER INVESTIGATION 4. NOT TREATING THE POLICYHOLDER WITH GOOD FAITH CLAIMS CONDUCT 5. LOOKING FOR WAYS TO REDUCE RECOVERY TO THE INSURED 6. LOOKING FOR WAYS TO DELAY FULL RECOVERY TO THE INSURED 7. NOT ADJUSTING CLAIMS AND EVALUATING LOSS PROPERLY, PROMPTLY AND FAIRLY TO PROVIDE FULL AND PROMPT INDEMNITY TO THE INSURED 8. FAILING TO IMPLEMENT PROPER STANDARDS FOR THE ADJUSTMENT AND INVESTIGATION OF CLAIMS 9. NOT TRAINING, SUPERVISING OR MANAGING ADJUSTERS PROPERLY SO THAT PROMPT AND FULL PAYMENTS ARE MADE, BUT RATHER PLACING THE COMPANY’S INTERESTS BEFORE THE POLICYHOLDERS’ INTERESTS 10. ESTABLISHING SEVERITY CONTROL INITIATIVES AND OTHERWISE ESTABLISHING A CULTURE OF NOT FULLY AND PROMPTLY PAYING CLAIMS FOLLOWING LOSSES 11. MATERIALLY MISREPRESENTING FACTS AND THE INSURANCE POLICY PROVISIONS To cure the defects outlined in this Civil Remedy Notice, the carrier must: (1) ADMIT FULL COVERAGE FOR THE INSUREDS’ LOSS; AND (2) THE TENDER $49,750.00 LESS THE APPLICABLE DEDUCTIBLE AND PLUS ANY STATUORY INTEREST OWED UNDER FLORIDA LAW. A copy of this form submitted to the FDFS has been transmitted to the following parties providing them notice of the filing of this Civil Remedy Notice: Certified Mail: 9589 0710 5270 0634 8033 40 ASI Preferred Insurance Corporation 2 ASI Way N. St. Petersburg, FL 33702 claims@email.americanstrategic.com.
Comments
User Id Date Added Comment
darryl_j_roles@progressive.com 12-27-2024 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 Dicus & Burke PLLC, on December 27, 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.

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DFS-10-363
Rev. 10/14/2008