Filing Number: 793871
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| Filing Accepted: 11/22/2024 |
| Last/Business Name
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ORRIOLS
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First Name |
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ARNALDO |
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| Street Address
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3051 SOMERSET PARK DRIVE |
| City, State Zip
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ORLANDO,
FL
32824
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| Email Address
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INTAKE2@THEKRFIRM.COM |
| Complainant Type:
*
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Insured |
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| Last/Business Name* |
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ORRIOLS |
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First Name |
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ARNALDO |
| Policy # * |
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FLA374751 |
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Claim #* |
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1432862-241001 |
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Attorney is Applicable
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| Last Name* |
KADIR
First Name *
ALI
Initial
A.
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| Street Address* |
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986 DOUGLAS AVE, STE. 102 |
| City, State Zip* |
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ALTAMONTE SPRINGS
,
FL
32714
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| Email Address * |
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INTAKE2@THEKRFIRM.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 STRATEGIC INSURANCE CORP.
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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 10872 |
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| Name of individual responsible for violation (if any):*
ASHLEY PIERCE, TANIA BROADNAX, MICHAEL D. LANE, SARAH M. SHAFFER, TSI ADJUSTERS INC., AND ALL AMERICAN STRATEGIC CLAIMS ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS WHO HANDLED THE CLAIM.
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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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Non-renewal
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Misrepresentation
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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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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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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.
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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(4) |
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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).
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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.
“We insure for sudden and accidental direct loss to property described Coverages A and B only if that loss is a physical loss to covered property.”
American Strategic possesses a complete copy of the subject insurance policy. Mr. Orriols is not in possession of a complete copy of the subject policy and is requesting a copy from American Strategic. Thus, this CRN cannot cite subject policy language verbatim due to such.
Notwithstanding, the subject policy is an all-risks insurance policy and the applicable policy language is the provision regarding coverage of all risks for the dwelling (Language such as “We insure against direct physical loss to property…”, “We insure against risk of direct loss to property…”, among other similar policy language etc. is typically used.) and provisions regarding exclusions or limitations to this all-risks provision.
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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.
Arnaldo Orriols is a homeowner insured with a policy issued by American Strategic Insurance Corp. (“American Strategic”). The insured property or home is located at 3051 Somerset Park Drive, Orlando, Florida 32824.
In October of 2024, Hurricane Milton caused extensive damage to Mr. Orriols’ home. Mr. Orriols timely reported an insurance claim for this damage to American Strategic and fully cooperated with all requests for inspections. He provided all requested documentation, if any, and complied with all post loss policy conditions.
After reporting the claim, American Strategic retained an unqualified and biased field adjuster who has a financial relationship with American Strategic. This field adjuster inspected Mr. Orriols’ home in an apparent effort to minimize American Strategic’s losses instead of adjusting the claim in good faith in due regard for Mr. Orriols’ interests.
Despite American Strategic finding coverage for his claim, it significantly undervalued Mr. Orriols’ claim at only $2,125.97. Because this amount is less than the subject policy’s deductible, American Strategic did not issue any payment to Mr. Orriols. Due to such, Mr. Orriols has not been able to permanently repair his home. Indeed, an estimate for repair of all damages with respect to his claim was prepared on behalf of Mr. Orriols for $32,428.98 and was submitted to American Strategic; well above the amount from American Strategic.
Based on these facts, it is clear American Strategic unreasonably denied full coverage for Mr. Orriols’ claim in bad faith through its extremely low and unreasonable undervaluation of his claim. Had American Strategic conducted a reasonable investigation based upon the available information, it would have been evident that affording greater coverage and issuing a substantially higher payment is warranted. Instead, it failed to adopt and implement standards for proper claim investigation as well as misrepresented pertinent policy provisions/facts rather than act fairly and/or honestly with Mr. Orriols in due regard for his interests. American Strategic also delayed the claim and failed to timely respond to communications. This has become a common business practice of American Strategic.
Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. American Strategic has breached this duty by refusing to properly and timely adjust the loss.
As a result, Mr. Orriols will have no choice but to retain the undersigned counsel to file a lawsuit against American Strategic.
American Strategic has more than enough information and is still refusing to accept coverage for this claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed.
American Strategic further mailed Mr. Orriols a Notice of Non-renewal. On this Notice of Nonrenewal, it lists the “Notice Date” as 10/23/2024 and the Date “Coverage Ends” as 02/28/2025 12:01 A.M.
American Strategic can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Mr. Orriols $20,868.98, which is the policy limit for coverage A less the 2% hurricane deductible.
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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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