Civil Remedy Notice of Insurer Violations
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Filing Number:     794220
Filing Accepted:  11/26/2024
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Complainant
Last/Business Name *  
SOTO   First Name   ROBERTO
Street Address * 2314 BUCKMINSTER CIR
City, State Zip * ORLANDO, FL 32803
Email Address * JULIA@KOWZANLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SOTO   First Name   ROBERTO
Policy # * ADP0008755 Claim #* AH14200
Attorney
Attorney is Applicable
Last Name* KOWZAN First Name * JULIA Initial
Street Address* 1401 E BROWARD BLVD, SUITE 201
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * JULIA@KOWZANLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN TRADITIONS INSURANCE COMPANY
NAIC Company Code 12359
 
Name of individual responsible for violation (if any):* ANY AND ALL REPS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : IMPROPER ADJUSTMENT
* 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(2) 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.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

COVERAGE A PROVISION. COVERAGE B PROVISION. COVERAGE C PROVISION. COVERAGE D PROVISION. ALL ADDITIONAL COVERAGE PROVISIONS. ALL COVERAGE PROVIDED BY ENDORSEMENT OR RIDER. THE DECLARATION PAGE. LOSS PAYMENT OR SETTLEMENT PROVISION. DUTIES IN THE EVENT OF LOSS. ALL TERMS AND CONDITIONS OF SECTION I OF THE INSURANCE POLICY THE INSURANCE POLICY DEFINITION SECTION. THE INSURANCE POLICY EXCLUSION OF COVERAGE PROVISIONS ALL INSURANCE POLICY PROVISIONS THAT PROVIDE COVERAGE TO THE INSURED PROPERTY. ALL POLICY PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Roberto Soto (herein “Insured”) is the owner of real property located at 2314 Buckminster Cir., Orlando FL 32803 (the “Property”). The Property is protected by a residential insurance policy issued by American Traditions Ins. Co. (herein “Insurer”, the “Carrier” or “AT”) numbered ADP0008755 with effective dates (see policy) (herein “Policy”). On or about 6-6-24, a sudden/accidental loss occurred, causing direct physical damage to the Property (the “Loss”), in the form of, to wit; wind, water and corresponding damages (see submitted estimate). Timely notice of the Loss was provided to AT along with records from Insured’s representatives that confirm the covered cause of Loss occurred here. When the Loss was reported to AT, it assigned claim number AH14200 (the “Claim”) to the Loss. The Insured complied with the Carrier’s minimal “investigation” of the Loss, permitted an adjuster for the Carrier to inspect the Claim damages; which they did. AT never had a roofer or other qualified expert inspect the Loss or Property before concluding its adjustment of the Claim. Conversely, AT was furnished by Insured with an estimate of the Claim damages along with photographs and a signed sworn proof of loss to the Carrier in substantiation of the Claim and damages. AT extended partial coverage for the Claim but significantly undervalued the damages associated with the Loss. In fact, it adjusted the Claim below the deductible and refused to issue fair payment for repairs. At all relevant times, the Insured (and its representatives) utilized their best efforts to work towards an amicable resolution of this matter and AT refused these efforts. Instead, opting to continue standing behind its insufficient investigation of the loss and improper adjustment of same. The Carrier has baselessly refused to properly pay or settle this Claim or correct its mistakes. The carrier must be held accordingly liable and accountable for such bad-faith conduct. Conversely, AT was not prejudiced in its investigation and was given full access to the Property and all available information and documentation. Despite same, AT still refuses to abide by the Policy or the Law in properly paying benefits due under the Policy to Insured, for the Claim damages. IN ALL, THE INSURER HAS FAILED TO: 1) PAY BENEFITS OWED 2) ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM. FURTHER HAS PLACED THE FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS. HAS FAILED TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS RETAINED TO REPRESENT THE POLICIES AND PROCEDURES OF THE INSURANCE COMPANY. THE INSURER IS LOOKING FOR WAYS TO DELAY BENEFIT PAYMENTS AND OTHERWISE "LOW BALL" OR "STONE WALL" THE CLAIM. THE INSURER HAS FAILED TO PROMPTLY PAY THE FULL BENEFITS OWED TO THE POLICY HOLDERS. THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF OUTSIDE ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY ADJUST AND PAY FULL BENEFITS AVAILABLE. THE INSURER MAY HAVE FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. THE INSURANCE COMPANY HAS FAILED TO CLAIM AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION TO EVALUATE CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES RESULTING IN STATUTORY VIOLATIONS AS SET FORTH ABOVE. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE AND EVALUATE THE CLAIM FOR DAMAGES. NOTWITHSTANDING THE TIMELY NOTIFICATION TO THE INSURANCE COMPANY OF THE CLAIM, THE INSURANCE COMPANY HAS DELAYED IN PAYING OR TENDERING ALL INSURANCE PROCEEDS DUE AND OWING IT UNDER THE INSURANCE POLICY. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO ACKNOWLEDGE AND ACT PROMPTLY UPON COMMUNICATION OF THE CLAIM. THE INSURANCE COMPANY HAS FAILED TO PROMPTLY SETTLE THE CLAIM WHEN THE OBLIGATION TO SETTLE THE INSURANCE CLAIM HAD BECOME REASONABLY CLEAR, UNDER ONE PORTION OF THE INSURANCE POLICY COVERAGE, IN ORDER TO INFLUENCE SETTLEMENT UNDER OTHER PORTIONS OF THE INSURANCE POLICY COVERAGE. TO DATE, NOTWITHSTANDING THE CONTRARY PLEAS, THE INSURANCE COMPANY HAS CONTINUED TO REFUSE TO ACKNOWLEDGE ITS OBLIGATION TO TENDER ALL THE INSURANCE PROCEED MONIES DUE AND OWING, OR ASSIST IN THE MITIGATION OF ITS DAMAGES. THIS CLAIM INVOLVES THE SERVICES PERFORMED BY SP AT THE PROPERTY THAT SUFFERED DAMAGES AND SINCE THE PROPERTY SUFFERED DAMAGES THE INSURANCE COMPANY HAS FAILED TO SATIATACTORY SETTLE THE CLAIM. THE LOSS WAS TIMELY REPORTED. AT THE TIME OF THE LOSS, THE INSURED PROPERTY WAS INSURED BY THE INSURANCE COMPANY. THE INSURED PAID ALL PREMIUMS AND THE POLICY WAS IN FULL FORCE AND EFFECT AT THE TIME OF THE LOSS. THE INSURED IS STILL FORCED TO EXPEND OUT-OF-POCKET EXPENSES IN SUBMITTING THE CLAIM TO FORCE THE INSURANCE COMPANY TO HONOR ITS OBLIGATIONS UNDER THE TERMS OF THE POLICY. THE CONCEPT OF INSURANCE IS THAT THE INSURER’S GRANTING OF TIMELY AND PROMPT INDEMNITY OR SECURITY AGAINST A CONTINGENT LOSS. SECTION 624.02, FLORIDA STATUTE, DEFINES “INSURANCE” AS A CONTRACT WHEREBY ONE UNDERTAKES TO INDEMNIFY ANOTHER OR PAY OR ALLOW SPECIFIED AMOUNT OR A DETERMINABLE BENEFIT UPON DETERMINABLE CONTINGENCIES. INHERENT IS THE FACT THAT PAYMENT MUST BE MADE TIMELY AND PROMPTLY SO THAT THE INSURED MAY MITIGATE THE DAMAGES AND TO PUT IT BACK IN THE POSITION IT WAS IN PRIOR TO THE LOSS. THE INSURANCE COMPANY HAS BREACHED THIS DUTY. THE INSURANCE COMPANY HAS REFUSED AND/OR FAILED TO TENDER ALL INSURANCE PROCEEDS DUE AND PAYABLE FOR THE CLAIM, UPON DEMAND. THE INSURANCE COMPANY’S REFUSAL AND/OR FAILURE IS WRONGFUL CONDUCT. THEREFORE, TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, THE INSURANCE COMPANY MUST: 1. IMPLEMENT ADEQUATE GUIDELINES FOR THE PROPER EVALUATION OF DAMAGE CLAIMS, AND FOR THE TRAINING AND SUPERVISION OF OUTSIDE ADJUSTERS WITH REGARD TO DAMAGE CLAIMS TO ENSURE THAT CLAIMS HANDLING PROCEDURES WITH REGARD TO THESE TYPES OF LOSSES ARE ADEQUATELY HANDLED TO STOP FURTHER INSUREDS FROM BEING TREATED UNFAIRLY AND WRONGFULLY. IN ADDITION, THE INSURANCE COMPANY MUST MONITOR THE ACTIONS OF OUTSIDE ADJUSTERS TO ADEQUATELY ENSURE ALL PERSONS ARE PROPERLY EQUIPPED AND TRAINED TO DETERMINE A LOSS OF THIS NATURE AND FAIRLY AND HONESTLY ASSIST THE INSUREDS. 2. IMMEDIATELY TENDER BENEFITS DUE AND PAYABLE. 3. MUST ACT FAIRLY AND HONESTLY TOWARDS THE INSUREDS/ITS ASSIGNEES AND WITH DUE REGARD FOR ITS INTEREST IN ATTEMPTING TO PROCESS AND SETTLE THE CLAIM. 4. MUST IMMEDIATELY TENDER ALL INSURANCE MONIES DUE AND OWING. INSURER HAS ALSO DENIED THE CLAIM IN BAD FAITH. THE LOSS OCCURRED AND WAS REPORTED TO THE INSURER AS TIMELY AS POSSIBLE UPON DISCOVERY OF THE DAMAGE. THE INSURER WAS GRANTED ACCESS TO THE PROPERTY TO INVESTIGATE THE LOSS/CLAIM AND THE INSURER INSPECTED THE PROPERTY. INSUREDS DID NOT PREJUDICE OR INTERFERE WITH THE CARRIER’S INVESTIGATION AND FULL ACCESS TO THE PROPERTY WAS GIVEN. DESPITE THIS, THE INSURER DENIED THE CLAIM FOR IMPROPER OR WHOLLY INSUFFICIENT REASONS AND ITS DECISION IS NOT VALID OR SUPPORTABLE. MEANWHILE, THIS IMPROPER TREATMENT AND DECISION IS DETRIMENTALLY AFFECTING AND CAUSING ONGOING DAMAGE TO THE INSUREDS IN DEPRIVING THEM OF NECESSARY COMPENSATION UNDER THE POLICY TO REPAIR THE PROPERTY, THAT SHOULD HAVE BEEN PAID BY ATIC IN RESPONSE TO THE CLAIM. Any and all rights are accordingly reserved to amend or supplement this statement, as discovery in this matter continues.
Comments
User Id Date Added Comment
hfleming@tlsslaw.com 01-24-2025 This will respond to the Civil Remedy Notice of Insurer Violations (“the Notice”) filed against AMERICAN TRADITIONS INSURANCE COMPANY (“ATIC”) on behalf of Roberto Soto (“Insured”), in connection with her claim for damage to her property. The Notice alleges unfair trade practice, claim delay, claim denial, unsatisfactory settlement offer and improper adjustment, as the reasons for filing the Civil Remedy Notice. The Insured alleges violations of Fla. Stat. §§624.155(1)(b)(1), (2) and (3), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), (b), (c), (d), (e), (f) and (g). As detailed below, the Notice does not comply with Florida law and its allegations lack merit. I. THE NOTICE DOES NOT COMPLY WITH FLORIDA LAW The purpose of a Civil Remedy Notice is to provide an Insurer with a chance to settle the claim and avoid unnecessary litigation. See The Heritage Corporation of South Florida v. National Union Fire Insurance Company of Pittsburgh, P.A., 580 F.Supp. 2d 1294 (S.D. Fla. 2008). In furtherance of this purpose, Fla. Stat. §624.155(3)(b) requires a Civil Remedy Notice “state with specificity” the statutory provision allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language relevant to the violation. As detailed below, the Notice does not satisfy the requirements of Fla. Stat. §624.155(3)(b). The Notice fails to reference with specificity the policy language allegedly violated, does not state specific facts for any of the Insured’s allegations, and only provides no names of any individuals within ATIC or otherwise that would have knowledge of the allegations. In Julien v. United Property & Casualty Ins. Co., No. 4D19-2763 [Fla. 4th DCA, September 23, 2020] directly addressed this issue. In affirming the trial court’s dismissal with prejudice of Plaintiff’s case, the 4th District Court of Appeal ruled the notice failed to satisfy the statutory requirement that an insured identify the specific statute and specific policy provision relevant to the alleged violation (emphasis added). This is precisely what is clearly lacking here. There is not a single specific policy provision noted in the entirety of the CRN. Finally, the Notice is facially insufficient as it does not fulfill the legislative purpose of providing the insurer with a bona fide opportunity to “cure” the alleged wrongdoing as required by law. See Talat Enterprises, Inc. v. Aetna Casualty & Surety Company, 753 So.2d 1278 (Fla. 2000). Fla. Stat. §624.155 contemplates the “cure” of an Insurer’s alleged statutory violations by the payment of the contractual amounts due. See Id. Here, the Insured has not made any efforts to define the amount being claimed and thus cannot be considered a legitimate cure demand. II. THE ALLEGATIONS OF THE NOTICE LACK MERIT In addition to the deficiencies outlined above, the allegations in the Notice lack merit and are not supported by the insurance policy, Florida law or the facts of the case. Interestingly, the Notice fails to mention that the Insured demanded appraisal PRIOR to this Notice being filed. The Insured demanded appraisal on November 18, 2022 and named his appraiser. ATIC responded on November 21, 2024 advising of its named appraiser. Additionally, on November 22, 2024, the Insured’s appraiser, Diego Ballina, emailed ATIC directly to advise they were invoking appraisal. ATIC responded and advised that it had send an appraisal letter and asked Mr. Diego to confirm receipt but no response was received. This case, as far as ATIC is aware is in the appraisal process. Appraisal was properly and timely invoked on this claim and was never revoked. This Notice is not valid under Florida law as it was not filed in compliance with §624.155(3)(f). This Notice was filed 8 days after the invocation of appraisal, in violation of Florida Statute. There are no facts to support any allegations of bad faith during the handling of this claim. ATIC complied with the policy of insurance with regard to the handling of the Insured’s loss. ATIC has in place guidelines and procedures designed for the proper investigation and evaluation of claims. They train and supervise their employees to treat every policyholder and claim with professionalism and in good faith. Their actions have been prompt and thorough, and the investigation conducted in good faith. ATIC has fully complied with the insurance policy and Florida law in connection with this claim. Therefore, the allegations contained in the Notice are denied in their entirety.
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.

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DFS-10-363
Rev. 10/14/2008