Filing Number: 793852
|
| Filing Accepted: 11/22/2024 |
| Last/Business Name
*
|
|
|
JOSEPH GREGORICH AND KATHLEEN GREGORICH
|
|
First Name |
|
|
|
| Street Address
*
|
|
209 SW 34TH ST |
| City, State Zip
*
|
|
CAPE CORAL,
FL
33914-50
|
| Email Address
*
|
|
HARLEYGRAMK@YAHOO.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
JOSEPH GREGORICH AND KATHLEEN GREGORICH |
|
First Name |
|
|
| Policy # * |
|
AGH271760 |
|
Claim #* |
|
CHO-00154384 |
|
Attorney is Applicable
|
| Last Name* |
OLADIPO
First Name *
ABIDEMI
Initial
A.
|
| Street Address* |
|
15257 AMBERLY DRIVE |
| City, State Zip* |
|
TAMPA
,
FLORIDA
33647
|
| Email Address * |
|
AOLADIPO@MSO.LAW |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 12841 |
|
|
| Name of individual responsible for violation (if any):*
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA, JAMES "SCOTT" HALBROOKS, MAURISSA FRANCIS, ZIPPEIRA TAYLOR; DISASTER SOLUTIONS, PRESTON CASE, ALONG WITH ALL ADJUSTERS, SUPERVISORS, MANAGERS, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY THE INSURER
|
| 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)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
| 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.
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
HOMEOWNERS 3 SPECIAL FORM
AGREEMENT
This policy is issued on behalf of the American Integrity Insurance Company of Florida and by acceptance of this policy, you agree:
1. That the statements in the Application(s) are your representations;
2. That this policy is issued in reliance upon the truth of those representations;
3. That this policy embodies all agreements existing between you and the American Integrity Insurance Company relating to this policy.
We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy. Based on the information “you” have given “us,” “we” agree to provide the insurance coverages indicated on the Policy Declarations. In return, “you” must pay the premium when due and comply with the policy terms and conditions.
…
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 dwelling 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.”
c. In-ground swimming pools including related permanently installed equipment such as pumps and filters.
…
COVERAGE B – Other Structures
1. We cover:
a. Other structures on the “residence premises” set apart from the dwelling by a clear space.
b. Other structures connected to the dwelling by only a fence, utility line, or similar connection.
c. Fences, whether attached or not attached to the dwelling.
…
COVERAGE C – Personal Property
1. Covered Property
We cover personal property owned or used by an “insured” while it is anywhere in the world. At your request, we will cover personal property owned by:
a. Others while the property is on the part of the “residence premises” occupied by an “insured”;
b. A guest or a “residence employee,” while the property is in any residence occupied by an “insured.”
…
COVERAGE D – Loss Of Use
We will pay the additional expenses you incur from a covered loss, but no more than the limit of liability shown for COVERAGE D – Loss of Use in the Declarations for the following:
1. Additional Living Expenses meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living when a loss covered under this Section makes that part of the “residence premises” where you reside not fit to live in.
Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere.
…
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
On March 9, 2022, American Integrity Insurance Company of Florida (“American Integrity”) issued Policy No. AGH271760 (the “Policy”) to Joseph Gregorich and Kathleen Gregorich (“Insureds”) for their home located at 209 SW 34th ST, Cape Coral, FL 33914-5033 (“Insured Property”) for the period of March 9, 2022 to March 9, 2023. The Policy provides Coverage A – Dwelling limits of $246,000.00; Coverage B – Other Structures limits of $2,460.00; Coverage C – Personal Property limits of $61,500.00; and Coverage D - Loss of Use limits of $24,600.00. The Policy provide coverage for direct damages to the Insured Property as a result of Hurricanes.
On September 28, 2022, Hurricane Ian, a catastrophic Category 5 hurricane, struck Florida, causing extensive damage to numerous communities, including Cape Coral. The sustained wind gusts and heavy rainfall directly damaged the Insured Property, particularly the roof, leading to interior water damage and compromising the Insured Property's insulation.
The Insureds promptly reported the claim to American Integrity and provided unfettered access for their agents to inspect the Insured Property. American Integrity assigned claim number CHO-00154384 and initiated the claims adjustment process. A field adjuster inspected the property on November 12, 2022, and based on his findings, American Integrity prepared an itemized estimate of damages through its representative, James “Scott” Hallbrooks, in the amount of $31,403.64. This estimate substantially underestimates the actual cost necessary to restore the Insured Property to its pre-loss condition by disregarding and excluding most of the damaged items.
Unfortunately, American Integrity and its agents demonstrated a lack of qualification to properly assess the damage or willfully ignored the full extent of the loss for potential financial gain. By misrepresenting the true scope of damages, American Integrity misrepresented pertinent facts or insurance policy provisions related to the coverage at issue, in violation of section 626.9541(1)(i)(3)(b) of the Florida Statutes. As a result, American Integrity issued a partial payment of only $11,831.87, which was insufficient for the Insureds to restore the Insured Property to its pre-loss condition. This determination was communicated by desk adjuster Maurissa Francis in a correspondence dated December 2, 2022.
Due to American Integrity's improper adjustment of the claim and its failure to act fairly and honestly toward its Insureds with due regard for their interests, the Insureds were compelled to handle the adjustment of the claim themselves. On February 24, 2023, the Insureds retained Noble Public Adjusting Group, LLC (“NPAG”) to assist in presenting their claim to American Integrity and facilitate the restoration of the Insured Property to its pre-loss condition. NPAG conducted an inspection of the Insured Property and produced an itemized estimate of damages totaling $296,950.18, which provided a more accurate assessment of the losses incurred on the date of loss compared to American Integrity's evaluation. Additionally, through NPAG, the Insureds submitted a notarized Sworn Statement in Proof of Loss (“SPOL”) on May 25, 2023, attesting to the damages incurred. American Integrity acknowledged receipt of SPOL on June 7, 2023. Despite this, American Integrity failed to revise its coverage determination, disregarded the Insureds’ plea for assistance, and continued to mishandle the claim.
Another example of American Integrity's incompetence in adjusting this claim is related to its retention of Preston Case from Disaster Solutions to assess the damages to the Insured Property. Despite Mr. Case's inspection, American Integrity failed to provide the Insureds or their representatives with his report. This omission constitutes a clear failure to adopt and implement standards for the proper investigation of claims, as mandated by Florida Statutes 626.9541(1)(i)(3)(a). During his inspection, the Insureds noted Mr. Case examined all windows and sliding doors of the Insured Property and took photographs. However, the Insureds were never provided with the report, leaving them without knowledge of American Integrity's basis for partially covering the claim.
Due to the severe damage sustained by the Insured Property and American Integrity's refusal to properly pay for the covered damages, the insured was forced to take immediate action to mitigate further loss. On November 16, 2022, the insured obtained an estimate from Saint Raphael Roofing, Inc. for roof replacement, totaling $24,210.00. This estimate was accepted, and the roof replacement work commenced shortly thereafter. To address additional damages, on January 18, 2023, the insured retained Wright Way Enclosures for repairs, which were documented in an invoice for $1,050.00. Furthermore, on January 23, 2023, the insured hired Restoration Solutions by Elite, LLC (“Elite”) for emergency mitigation services, as reflected in an invoice totaling $41,946.50. Additionally, on June 4, 2023, R Values Insulation, LLC, issued the invoice no. 1322 for the installation of Fiberglass insulation in the amount of $2,690.00. Moreover, on May 2, 2023, the Insureds retained T&K Construction and Remodeling LLC for further repairs in the amount of $12,600.00 and Slider Man on May 2, 2023, for the installation of panels, totaling $169.00.
After retaining legal representation and submitting additional documentation to support their claim—despite the fact that this was not the responsibility of the Insureds—American Integrity issued another partial payment of $24,973.45 on February 2, 2024. However, this amount still falls short of the total costs required to restore the Insured Property to its pre-loss condition. American Integrity did not 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 in violation of 626.9541(1)(i)(3)(f) Florida Statues.
As of the date of this loss, American Integrity has failed to properly adjust and settle this claim in good faith, despite numerous opportunities provided by the Insureds. In contrast, the Insureds have diligently fulfilled all Duties After Loss outlined in the Policy, including timely reporting of the claim, granting unfettered access to American Integrity for inspection of the Insured Property, and providing all requested documentation to support the loss. To mitigate further damage, the Insureds have undertaken various repairs to the Insured Property, hiring a mitigation company to confirm water damage to the attic, removing drywall and flooring in affected areas, and gutting the house to prevent further deterioration. Additionally, they obtained portable air conditioning units to maintain a safe environment. Despite these efforts, American Integrity has refused to provide coverage for this loss, including loss of use coverage, to which the Insureds are entitled due to the Insured Property's uninhabitable conditions following the loss.
In Florida, the work of adjusting insurance claims engages the public trust. American Integrity has breached the public’s trust by its adjustment of the Insureds’ claim of loss. American Integrity has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. American Integrity has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ claim for damages. American Integrity has failed to promptly settle the Insureds’ claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the Insureds’ pleas otherwise, American Integrity has continued to refuse to acknowledge its obligation to conduct a proper investigation.
Moreover, American Integrity has not attempted in good faith to settle the Insureds’ 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. American Integrity has done everything possible to delay and/or deny the claim. Furthermore, American Integrity 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…”). American Integrity was timely put on notice of the Insureds’ loss and claim for damages. The Insureds have complied with all of American Integrity’s requests to date and the carrier has still failed to treat this claim with good-faith. This intentional delay with the claim has led to direct prejudice of the Insureds, who continue to be held hostage unless/until American Integrity engages in good faith claims handling. To date, American Integrity has still refused to fully pay the amount owed under the Policy. To make matters worse, the Insureds have incurred incredible costs and efforts to adjust their own loss, with detailed and substantiated damages presented to American Integrity in the form of a repair estimate evidencing $296,950.18 in Replacement Cost Valuation. American Integrity Insurance’s stubborn and/or negligent refusal to fully indemnify the Insureds for the covered damages has resulted in a confluence of consequential damages including, but not limited to, excess damages stemming from American Integrity’s maladroit adjustment of the claim, the unaffordability of the Insured Property given the loss of utility and the indefinite delay to address the ongoing dispute, additional costs and expenses to adjust its own loss that include retaining a public adjuster and an attorney, among many other otherwise unnecessary consequences but for the negligence and nefarious business practices of American Integrity.
It is clear that American Integrity Insurance is not treating the Insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insureds; and ignoring the Insureds’ pleas for assistance; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing American Integrity’s interests before the Insureds’ interests; refusing to pay the full amount owed to the Insureds despite the fact that American Integrity has been on notice of the damages and looking for ways to delay and/or deny full recovery to the Insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. American Integrity’s actions are in violation of Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), and 626.9541(1)(i)(3)(h), Florida Statutes.
All of the aforementioned are part of what appears to be an ongoing pattern and practice of behavior by American Integrity that demonstrates a wanton and reckless disregard for insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, American Integrity must: (1) Create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future; (2) American Integrity must create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees with regard to these type of claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other insureds from being treated unfairly and wrongfully; (3) American Integrity must pay the Insureds $296,950.18 for all of the damages sustained as a result of the loss, less the applicable deductible, limitations, plus all contractual damages owed, attorney’s fees, costs and interest, under Sections 57.041 and 627.70131(5)(a) Florida Statutes; and (4) American Integrity must act fairly and honestly towards its Insureds and with due regard for their interests in attempting to settle its Insureds’ claim.
|
|
|
*
|
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
|