Civil Remedy Notice of Insurer Violations
Login

Filing Number:     794138
Filing Accepted:  11/26/2024
         Print Filing
Complainant
Last/Business Name *  
CHAU   First Name   LEO AND THY
Street Address * 5771 MARINA ROAD
City, State Zip * BOKEELIA, FL 33922
Email Address * ROBERT@WINDLAWGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CHAU   First Name   LEO AND THY
Policy # * AGH0386843 Claim #* CHO-00132947
Attorney
Attorney is Applicable
Last Name* GALLAGHER First Name * ROBERT Initial
Street Address* 8570 STIRLING RD., SUITE 102-406
City, State Zip* HOLLYWOOD , FL 33024
Email Address * ROBERT@WINDLAWGROUP.COM
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):* THE ASSIGNED DESK ADJUSTER, FIELD ADJUSTER, SUPERVISOR(S) AND/OR MANAGER(S); AND ANY OTHER INDIVIDUAL THAT HAS REVIEWED THIS CLAIM OR MADE DETERMINATIONS WITH RESPECT TO THIS CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections, all endorsements and changes to the subject policy are relevant to the insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about September 28, 2022, while the insurance policy (Policy Number: AGH0386843) was in full force and effect, the subject property located at 5771 MARINA ROAD BOKEELIA, FL 33922 sustained a covered loss as a result of wind and water damage from Hurricane Ian. This was a Category 5 hurricane, and when it struck Florida, it was a strong Category 4 hurricane that devastated the state. The insured filed a claim (Claim Number: CHO-00132947) per the terms of the insurance policy with AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA (the “carrier”). AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. The carrier’s adjuster did not properly adjust the loss to include obviously related damages resulting from Hurricane Ian. After the carrier’s inspection, AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA opened coverage for the loss and offered a miniscule payment of $92,542.68 to repair all the damages. This amount is a gross under-valuation of the claim and is not close to what is needed to restore the subject property to its pre-loss condition, even when accounting for the deductible and depreciation. The insured retained a representative, who performed a comprehensive investigation of the subject property that identified the damage that the carrier knew existed but failed to address. The insured’s representative determined there were damages and repairs necessary to restore the property to its pre-loss condition and submitted claim-related documentation to AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA, including a detailed estimate for repairs for $235,984.83. After offering its initial payment, AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA made it clear that it had no intention of dealing fairly with the insured and properly addressing the gross discrepancy between its offer and the insured’s estimate. Once it became abundantly clear that AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA had no intention of acting in good faith, the insured was forced to file the instant Civil Remedy Notice. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA have approached this investigation in a manner prejudicial to the insured. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA is using either untrained or improperly trained adjusters in connection with this claim. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA should have been fairly adjusting this claim, but instead, it was looking for ways not to pay the claim at all or not pay the claim in full. Most notably, the carrier responded to the Insured’s Notice of Intent making an offer to resolve the claim for $25,000. A number well below the outstanding amount owed. When the Insured refused to accept, the Carrier attempted to compel DFS Mediation under Florida Statute, despite the fact that the Carrier chose to respond to the NOI with a low ball offer. Yet another delay tactic and statutory violation by the Carrier. The above are all examples of AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA’S unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. These actions demonstrate the carrier is 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 the insured. The insured gives this notice to perfect the right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: (1) Pay the complete covered loss in the amount of $235,984.83, less any prior payments and less any applicable policy deductible; (2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and (3) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim.
Comments
User Id Date Added Comment
swozniak@aii.com 12-10-2024 December 10, 2024 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, Florida 32399-0322 Robert Gallagher, Esq. 8570 Stirling Road Suite 102-406 Hollywood, Florida 33024 Robert@WindlawGroup.com Re: DFS File No: 794138 Complainants: Leo and Thy Chau Insureds: Leo and Thy Chau Policy No: AGH0386843 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00132947 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Robert Gallagher, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on November 26, 2024 and assigned it DFS File No. of 794138. While American Integrity asserts that the subject CRN is legally insufficient and non-compliant with Florida law, American Integrity, without waiving any arguments regarding same, contends that it has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its Insureds, Leo and Thy Chau. The CRN contains a list of purported violations which are alleged to have been committed by American Integrity. In fact, none of the listed violations/allegations have occurred and/or are irrelevant to the alleged violations and American Integrity categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules contained in the CRN. In addition, American Integrity denies any and all allegations of any kind and/or any inferences therefrom referenced and/or contained in the CRN. American Integrity believes this response adequately addresses the allegations and violations contained within the CRN. Sincerely, Michael S. Sperounes Michael S. Sperounes, Esq. Senior Vice President of Litigation American Integrity Insurance Group cc: Robert Gallagher, Esq. via email at: Robert@WindlawGroup.com CRN Response If this document contains an excerpt from an American Integrity Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the Insureds on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234
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.

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