Filing Number: 794196
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| Filing Accepted: 11/26/2024 |
| Last/Business Name
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JEAN-LOUIS
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First Name |
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JEAN-CLAUDE & NADEGE AGENOR |
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| Street Address
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8089 GOPHER TORTOISE TRAIL |
| City, State Zip
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LEHIGH ACRES,
FL
33972
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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JEAN-LOUIS |
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First Name |
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JEAN-CLAUDE & NADEGE AGENOR |
| Policy # * |
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FLA395805 |
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Claim #* |
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1424040-241001 |
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Attorney is Applicable
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| Last Name* |
SHERMAN
First Name *
RYAN
Initial
H
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| Street Address* |
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18801 NE 21ST AVENUE |
| City, State Zip* |
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MIAMI
,
FL
33179
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| Email Address * |
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RYANSHERMANFL@GMAIL.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):*
CHRIS MURRAY
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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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| 626.9541(1)(i)(2) |
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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.
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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.
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 covered property. We do not insure, however, for loss:
...
2. Caused by:
...
e. Any of the following:
1. (1) Wear and tear, marring, deterioration;
2. (2) Inherent vice, latent defect, mechanical breakdown;
...
(6) Settling, shrinking, bulging or expansion, including resultant cracking, of
pavements, patios, foundations, walls, floors, roofs or ceilings; ...
3. Excluded under Section I – Exclusions.
Under items 1. and 2., any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.
SECTION I – EXCLUSIONS
...
2. We do not insure for loss to property described in Coverages A and B caused by any of
the following. However, any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.
...
c. Faulty, inadequate or defective:
...
2. (2) Design, specifications, workmanship, repair, construction,
remodeling, grading, compaction;
3. (3) Materials used in repair, construction, renovation or remodeling; or
4. (4) Maintenance;
of part or all of any property whether on or off the "residence premises." ...
renovation,
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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.
On or about September 26, 2024, the Insureds suffered a loss on account of water and wind causing damage to Insureds’ property (hereinafter “Hurricane Helene Claim”). The Insurer assigned claim number 1424040-241001 to the Hurricane Helene Claim.
After conducting an investigation on the Hurricane Helene Claim, Insurer acknowledged coverage, and issued a partial post-deductible payment totaling $358.85 to the insureds.
However, said partial payment was woefully inadequate, and does not come close to compensating Insureds for their total post-deductible damages in the amount of $60,016.93.
As such, Insurer has failed to fully indemnify the Insureds for their Hurricane Helene Claim as it was contractually obligated to do pursuant to the subject Policy.
Insurer violated numerous Florida Statutes in its handling of Insureds’ Hurricane Helene Claim.
Insurer did not attempt in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests, specifically when it was apparent the Insureds’ damages far exceeded that of the Insurer’s estimate, per the Insureds’ estimate identifying the deficiency in both the scope and costs of repairs to return the property to its pre-loss condition.
Insurer made a material misrepresentation, and misrepresented pertinent facts or insurance policy provisions relating to Coverages at issue, when it failed to acknowledge coverage for the under-scoped, underpriced, and simply overlooked repairs to various damages throughout the property, and did so for the purpose and with the intent of effecting settlement of such claims, loss or damage on less favorable terms than those provided in the policy.
As evidenced by the aforementioned actions, Insurer clearly failed to adopt and implement standards for the proper investigation of claims, and effectively denied the remainder of Insureds’ claim without conducting reasonable investigations based on available information.
Insurer can cure this breach by paying insurance monies due and owed to the Insureds that would reasonably place Insured back to their pre-loss condition, as well as compensating the Insured for all Additional Living Expenses, as well as any and all reasonable attorney’s fees and costs incurred by her to date in connection with this claim and stemming from the aforementioned violations by the Insurer. This notice is given in order to perfect the right to pursue the Civil Remedy Authorized by this section.
NOTE: As any information contained herein becomes part of the public record, the Insureds have withheld their email address so as to not make same available for public review. Furthermore, as the Insureds are represented by counsel, it would be improper for any representative of the Insurer to contact the Insureds directly for any reason utilizing their email address and, as such, the information is neither material to the Insurer’s ability to correct the violations contained herein nor required by the Department of Financial Services. The Insurer should direct all follow up correspondences to the attorney listed above.
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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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