Civil Remedy Notice of Insurer Violations
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Filing Number:     794441
Filing Accepted:  11/27/2024
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Complainant
Last/Business Name *  
VEGA   First Name   ANNA
Street Address * 15433 LAKESHORE VILLA DRIVE, LOT 74
City, State Zip * TAMPA, FL 33613
Email Address * CDP@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   VEGA   First Name   ANNA
Policy # * ATM173350 Claim #* AM150539
Attorney
Attorney is Applicable
Last Name* PAGAN First Name * CHRISTOPHER Initial D
Street Address* 800 EAST BROWARD BOULEVARD, SUITE 510
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * CDP@WEKLAW.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):* ARBIE RAY AND KATHLEEN HABIB
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)(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.

Property Coverages - Coverage A Perils Insured Against - Coverage A Loss Settlement Provision of Conditions
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Anna Vega ("Insured") purchased an insurance policy ("Policy") from American Traditions Insurance Company ("ATIC" or “Carrier”) with effective coverage on the date of loss, on or about August 30, 2023, and Policy number ATM173350 to insure her property located at 15433 Lakeshore Villa Drive, Lot 74, Tampa, FL 33613 (the "Property").?? On or about August 30, 2023, the Property suffered severe damage as the result of Hurricane Idalia, which caused ensuing damages to the Property including but not limited to the roof and interior of the property ("Loss"). ATIC was notified of the Loss and was granted access to the property in order to complete their inspection. ATIC acknowledged the claim and assigned claim AM150539 ("Claim") to the Loss. On October 30, 2024, Arbie Ray, a claims examiner on behalf of ATIC authored a letter to the Insured (“Coverage Letter”) stating that the damages were not covered under the policy and that no payment was forthcoming. Then, on June 7, 2024, in response to the Insured’s Notice of Intent to Litigate, Arbie Ray authored a letter confirming that the claim was being denied; however, offering $10,000.00 to settle the claim, which is insultingly low. After being provided plenty of evidence (including photos, estimates, and immediate access to the property upon discovery) showing that damage from a windstorm event occurred at the property that will require extensive repairs, ATIC continues to refuse to provide any money in order to complete these repairs. ATIC also has the ability to determine the costs needed to fully repair this property but has not attempted to discover this information and has instead forced the Insured to pursue legal recourses for the money due and owing under the contract of insurance. ATIC is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair her home. The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, ATIC has unequivocally failed to properly adjust this Claim, as elaborated above. ATIC has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, ATIC has acted with only its own profit and shareholders in mind. As a direct consequence of ATIC’s failure to adjust this Loss in good faith and make any coverage payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured’s Property more than one year ago.?? By stating the above detailed?facts,?it is clear that ATIC has violated the following Florida statutes:? • 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 Insureds and with due regard for their interest. • 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims; • 626.9541(1)(i)(3)(i) Unfair claim settlement practices. To date, ATIC has in bad faith failed to provide sufficient coverage under the Policy to the Insureds. As a direct result of ATIC’s underpayment of the Claim and breach of the Florida Statutes, the Insured was?forced to seek the?help of licensed professionals to assist her, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that ATIC knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of ATIC’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made the property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, ATIC failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.? To deny the Insured the benefits clearly due and owing under the Policy, for which they been making premium payments for and after they have satisfied all of his obligations is morally and ethically reprehensible and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by ATIC so often?as to constitute a general business practice, evidencing a motive to enhance ATIC’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that ATIC adjusted this claim in bad faith, continue to act in bad faith towards its Insureds and that ATIC is in direct violation of Unfair Claims Practices.?? This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should ATIC fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, ATIC must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($45,635.00 less any applicable deductible); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds\ for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
cdp@weklaw.com 08-25-2026 This CRN is hereby withdrawn.
cwahab@bressler.com 01-24-2025 Dear Mr. Pagan: Please accept this response on behalf of American Traditions Insurance Company (hereinafter “American Traditions”) to the Civil Remedy Notice of Insurer Violations (hereinafter “CRN”) No. 794441, filed on behalf of Anna Vega (hereinafter, the “Complainant” or the “Insured”), and accepted by the Florida Department of Financial Services on November 27, 2024. The Civil Remedy Notice (“CRN”) alleges that American Traditions violated the following statutes: • 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)(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 period required by s. 627.736(4)(b). Please accept this as American Traditions’ response to the above-referenced CRN filed with the Department of Financial Services by the Complainant, Anna Vega. To summarize the below, American Traditions hereby denies any allegation of not attempting to settle claims in good faith when it could and should have done so; failing to promptly settle claims when the obligation to settle a claim has become reasonably clear; failing to adopt and implement standards for the proper investigation of claims; failing to acknowledge and act promptly upon communications with respect to claims; and failing to pay personal injury protection insurance claims, and states that it has at all times handled and adjusted the Complainant’s claim with utmost good faith. Simply put, American Traditions denies any acts or omission that could be construed or found to be deemed bad faith and/or a violation of Florida Statutes § 624.155 and § 626.9541, whether expressly stated in the Civil Remedy Notice or implied. Any and all allegations of bad faith are hereby denied and rejected in their entirety by American Traditions. Beyond American Traditions’ adamant belief that it acted with the utmost good faith, the CRN is deficient and fails to preserve any and all claims for statutory bad faith under Florida Law. As an initial matter, American Traditions denies and rejects the instant CRN as it fails to comply with the requirements of Florida Statute § 624.155. The CRN is therefore deficient and fails to preserve any and all claims for statutory bad faith under Florida Law. Florida Statute § 624.155 requires a complainant to file with the Department of Financial Services a Civil Remedy Notice which shall be “on a form provided by the [Department] and shall state with specificity…such other information as the Department may require.” The Department created a CRN form, Form DFS-10-363, which lays out 15 requirements, including in part, the Complainant’s e-mail address, Complainant type, claim number, attorney’s name, attorney’s address, attorney’s e-mail address, type of insurer, the person with knowledge of the facts giving rise to the allegations, and the reason for notice. According to § 624.155, these mandates are required by the Department, and they must be stated with specificity. The instant CRN fails to provide the specificity required by § 624.155 and fails to comply with the form requirements as a whole. Therefore, the instant CRN is facially deficient. See Bay v. United Servs. Auto. Ass’n, No. 4D19-3332, 2020 WL 6154256 (Fla. 4th DCA Oct. 21, 2020). Specifically, the instant CRN filing lists the Complainant’s e-mail address as “CDP@WEKLAW.COM,” the same e-mail address listed for the Complainant’s attorney and not the Complainant’s true e-mail address. Withholding the Complainant’s e-mail address within the CRN, and/or including the same one for the Complainant as for their counsel, is insufficient under Florida law to support any action for bad faith against American Traditions without speculation on its part. Due to this intentional withholding of mandated information, the CRN is facially deficient as it fails to comply with the form requirements set forth in Florida Statute §624.155, and specifically § 624.155(3)(b)(3). See Bay v. United Servs. Auto. Ass’n, No. 4D19-3332, 2020 WL 6154256 (Fla. 4th DCA Oct. 21, 2020). Furthermore, the CRN’s attempt to identify the specific policy language relevant to the violation is woefully deficient. “Courts have found that listing whole sections of the insurance policy constitutes insufficient specificity.” See Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294 at *2 and Julien v. United Property & Casualty Insurance Company No. 4D19-2763 (Fla. 4th DCA 2020).” When prompted to reference the policy language that is relevant to the alleged violation, the Complainant makes absolutely no effort to provide the relevant policy language. Instead, the Complainant lists Property Coverages – Coverage A, Perils Insured Against – Coverage A, Loss Settlement Provision of Conditions.” The Complainant blatantly ignored the Department’s heading, seeking “[r]eference to specific policy language that is relevant to the violation,” and makes no attempt to provide such. Instead, the Complainant provided a low-effort and minimally informative list of some of the subject insurance policy’s section headings, without reference to any specific language which it alleges has been breached or is called to question. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Florida Statute § 624.155. Julien v. United Property & Casualty Insurance Company No. 4D19-2763 (Fla. 4th DCA 2020). Failure to provide specific reference to any relevant policy language is direct and clear noncompliance with the requirements of Florida Statute § 624.155, and therefore renders the CRN deficient on its face as to form and substance. For these reasons alone, the CRN fails at its inception. Additionally, the CRN fails to provide a complete description relating to the facts and/or circumstances which give rise to the alleged statutory violations, thus, prejudicing American Traditions from providing any meaningful or complete response. In summary, the CRN is hardly more than a recitation of a number of Florida statutory provisions, with minimal factual allegations in support of the conclusory statutory recitations. A Civil Remedy Notice must state the facts and circumstances that give rise to an alleged violation with specificity sufficient to allow an insurer to cure the alleged violation within the sixty-day statutory period. Lane v. Westfield Insurance Company, 862 So.2d 774 (Fla. 5th DCA 2003). The instant CRN therefore fails to comply with the requirements of Florida Statute § 624.155(3), which requires that a CRN of insurer violation “state with specificity,” inter alia, the facts and circumstances giving rise to the violation and the “specific” language of the subject insurance policy that is relevant to the violation. The CRN fails to specify what was lacking in American Traditions’ investigation and fails to specify facts which support that its investigation was unfair or merits additional steps. To American Traditions’ knowledge, the instant claim for insurance benefits has been adjusted and/or repaired properly. The CRN further lacks any specificity, facts, or rationale which indicate that American Traditions’ coverage determination should have been different. Generally, the CRN lacks the requisite facts and/or specificity, as ruled on numerous times and cited to throughout this Response, to put American Traditions on notice as to the allegations against it. Moreover, the few facts that are stated in the CRN are contrary to the facts of the underlying claim or are at best misleading. The CRN states that “[American Traditions] also has the ability to determine the costs needed to fully repair this property but has not attempted to discover this information…” However, this statement is blatantly untrue. Also, the CRN claims that, “[American Traditions] is trying to avoid finding any further information that would increase the amount of coverage available on this claim…” Again, this statement is plainly false. Rather, American Traditions did inspect the property through an independent licensed field adjuster who found no evidence of hurricane related damage or any storm created opening throughout the subject property. In written correspondence to the insured Complainant dated October 30, 2023, American Traditions explained the field adjuster’s observations and their resulting position as to the Complainant’s claim. The Complainant has provided no facts or evidence to support these allegations in support of the instant CRN or in any other context throughout the entirety of their claim. Despite the timing of the claim, American Traditions promptly and thoroughly investigated the subject claim and reached its coverage determination based upon its complete understanding of the facts. However, the instant CRN makes vague and unsupported allegations while the reality is that American Traditions systematically inspected and investigated the subject claim and timely relayed its findings to the Complainant based upon its complete review of the claim’s facts. It is the Complainant who is not complying with the policy’s terms and who is continuing to make unsupported allegations in an attempt to deceive American Traditions to issue unwarranted payments and/or additional benefits. The subject CRN makes egregious and baseless allegations that “[American Traditions] has unequivocally failed to properly adjust this Claim…,” and “[American Traditions] has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly toward the policyholder… Rather, [American Traditions] has acted with only its own profit and shareholders in mind.” These are serious blanket allegations made without one scintilla of factual evidence in support of any of such claims. As demonstrated by the facts outlined above, American Traditions diligently investigated the subject loss, repeatedly and routinely communicated with the Complainant, and acted accordingly based upon the facts it discovered throughout its investigation of the claim and according to the terms of the insurance contract which provides rights to both the Complainant as well as the insurer for scenarios just like this one. American Traditions’ investigation of the subject claim was swift and routine: American Traditions received a claim for damages, American Traditions sent a representative to inspect the property, American Traditions reviewed the representative’s observations and applied the relevant policy language thereto, ultimately resulting in a claim denial based on the relevant information. Had their investigation revealed that the insured Complainant’s property sustained covered damages, then the claim determination would have been different. The Complainant’s cure demand is indiscernible and as such American Traditions is not given a fair opportunity to cure the CRN. The CRN states: “… to cure the defects outlined in this [CRN], [American Traditions] must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($45,635.00 less any applicable deductible); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds\ for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.” This is the functional equivalent of “Pay me everything I’ve asked for.” Rousso v. Liberty Surplis Ins. Co., 2010 WL 736059, *5 (S.D. Fla. 2010). “Insurers are not required to pay any amount demanded by their insureds to avoid a bad-faith claim.” Id. (citing 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1194 (N.D. Fla. 2008)). However, regardless of its legitimacy, the CRN itself contains a cure in the form of an admission of liability and American Traditions cannot even begin to attempt to cure the instant CRN on such unclear terms. In addition to demanding “everything I’ve asked for,” the cure is unclear as to what it’s asking for beyond the stated monetary amount. The cure provides no basis for American Traditions to even attempt to calculate what it seeks when demanding several payments and reimbursements. Rather, the cure demand is merely an attempt to deceive American Traditions into issuing some ambiguous payment rather than defending itself against a threat of bad faith when no bad faith is remotely existent anywhere throughout the instant claim. Given the cure, American Traditions affirmatively asserts that the CRN is deficient. Since no other distinct basis for a cure has been set forth by the Civil Remedy Notice, American Traditions was not provided with a reasonable opportunity to purge any alleged violations. See Kafie v. NorthWestern Mut. Life Ins. Co., 834 F. Supp. 2d 1354, 1359 (S.D. Fla. 2011) (“In order to demonstrate good faith, ‘[t]he insurer must investigate the facts, [and] give fair consideration to a settlement offer that is not unreasonable under the facts…’”). Based on the facts provided, it is impossible for American Traditions to satisfy the Complainant without significantly prejudicing itself, and therefore the CRN fails to provide a true and feasible cure method. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Florida Statute § 624.155. Similarly, for these reasons, the CRN fails. As outlined above, contrary to the allegations made by the CRN, American Traditions sufficiently and diligently investigated the loss. American Traditions maintains that it has acted fairly and honestly toward the Complainant, and any other person having an interest in the subject policy or assisting the Complainant in connection with the instant claim. American Traditions consistently and promptly communicated with the Complainant and/or their agents throughout all stages of the investigation and conducted a thorough investigation in good faith. To the extent that the instant CRN is intended to address any other facts or circumstances which purport to establish additional coverage for the reported losses, the CRN provides insufficient identification of any such facts or circumstances and therefore prevents American Traditions from addressing any other aspect herein. Notwithstanding, American Traditions believes that the above facts demonstrate beyond dispute that it has at all times acted in good faith with regard to its investigation of the subject claim, and further believes that the facts provided to date fail to establish that it has not adjusted the reported loss in accordance with the express terms, provisions, limitations and exclusions contained within the policy. If we can provide any additional information, or be of any further assistance, please do not hesitate to contact us at your earliest convenience. Very truly yours, s/ Chafic R. Wahab _ Chafic R. Wahab, Esq.
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