Filing Number: 793255
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| Filing Accepted: 11/19/2024 |
| Last/Business Name
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| Street Address
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119 WYNNFIELD DR, |
| City, State Zip
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PALM COAST,
FL
32164
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| Email Address
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TS@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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TOWNS |
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First Name |
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BETTY |
| Policy # * |
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AGD298764-07 |
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Claim #* |
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CDP-00114624 |
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Attorney is Applicable
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| Last Name* |
SCHILLING
First Name *
TAWNA
Initial
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| Street Address* |
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708 E. COLONIAL DRIVE, SUITE 103 |
| City, State Zip* |
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ORLANDO
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FL
32803
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| Email Address * |
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TS@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 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):*
JEAN-LUC BENOIT, CLAIMS ADJUSTER AND OTHER EMPLOYEES AND/OR AGENTS OF INSURER
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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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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
AGREEMENT
…
We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy. …
DEFINITIONS
14. "Insured location" means:
a. The "residence premises";
b. The part of other premises, other structures and grounds used by you as a residence and
(1) Which is shown in the Declarations; or
(2) Which is acquired by you during the policy period for your use as a residence;
…
17. "Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions, which results, during the policy period, in:
…
b. "Property damage".
26. "Property damage" means physical injury to, destruction of, or loss of use of tangible property.
SECTION I – PROPERTY COVERAGES
Coverage A – Dwelling
1. We cover:
a. The dwelling on the "residence premises" shown in the Declarations, including attached structures and attached wall-to-wall carpeting if damage to the welling is caused by a covered loss.
b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises".
SECTION I – PERILS INSURED AGAINST
Coverage A – Dwelling And Coverage B – Other Structures
1. We insure for sudden and accidental direct loss to property described in Coverage A - Dwelling and Coverage B – other Structures only if that loss is a physical loss to covered property.
SECTION I – CONDITIONS
10. Loss Payment
We will adjust all losses with you.
We will pay you unless some other person is named in the policy or is legally entitled to receive payment. …
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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.
American Integrity Insurance Company (Insurer) acted in bad faith in its dealings with Betty Towns (Insured) regarding a direct physical loss to their property located at 119 Wynnfield Dr, Palm Coast, FL 32164 (Property) on June 17, 2021 (DOL) violating Fla. Stat. § 624.155. Fla. Stat. § 624.155 provides a cause of action for bad faith in first-party claims. Fridman v. Safeco Ins. Co., 185 So. 3d 1214, 1220 (Fla. 2016). These first-party claims are treated the same as third-party claims. Id. at 1221. The question of whether an insurer acted in bad faith is determined by the “totality of the circumstances” standard. Berges v. Infinity Ins. Co., 896 So. 2d 665, 680 (Fla. 2004). This inquiry focuses on the actions of the insurer. Id. at 677. The insurer has a duty to use the degree of care and diligence as a person of ordinary care. Bos. Old Colony Ins. Co. v. Gutierrez, 386 So. 2d 783, 785 (Fla. 1980). The insurer must investigate the facts, give fair consideration to all settlement offers, and settle when a reasonable prudent person would. Id. Additionally, an insurer must not act solely in their own interest in settlement. State Farm Mut. Auto Ins. Co. v. LaForet, 658 So.2d 55, 58 (Fla. 1995). Furthermore, the insurer has the burden to show that there was no realistic possibility of settlement. Powell v. Prudential Prop. & Cas. Ins. Co., 584 So. 2d 12, 14 (Fla. 3d DCA 1991).
Insurer acted in bad faith under Fla. Stat. § 624.155(1)(b)(1) by 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 their interests. Specifically, INSURED provided an estimate from a roofing contractor and submitted said estimate to Insurer for a total of $ 38,665.99. Insurer determined the damages were covered but woefully underestimated the cost to repair the property at $670.38, failed to adjust the claim with INSURED and refused to issue payment. See Seigel v. Tower Hill Signature Ins. Co., 225 So. 3d 974 (Fla. 3d DCA August 30, 2017) (insurance carriers are not entitled “to unilaterally determine, as a matter of law, actual cash value or replacement case value.”)
When Insurer failed to pay the benefits owed, Insured was left with no recourse other than to pursue full indemnity in the Circuit Court of Flagler County. See Betty Towns v American Insurance Company, filed in the Circuit Court of the 7th Judicial Circuit in and for Flagler County, Florida, case number
2023 CC 000761
The handling, adjustment, underpayment, and continued failure to meet its obligations under the policy has resulted in multiple breaches of the subject policy of insurance, is in clear violation of Florida Statutes, ethical considerations, the adjuster code of conduct and the administrative code provisions. These include, but are not limited to, Florida Statute §624.155. Insurer at all times material hereto, acted for its own interest and not for the interest of the Insured as set forth in detail above. In so doing, Insurer has taken positions in defending its actions and/or omissions on theories that have no basis in law, no basis under the subject policy, and have no basis in fact.
In order to remedy the above referenced violations Insurer must promptly fairly and honestly engage in good faith settlement negotiations with Insured and their representatives
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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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