Civil Remedy Notice of Insurer Violations
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Filing Number:     794721
Filing Accepted:  12/2/2024
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Complainant
Last/Business Name *  
PETERSON   First Name   JADA
Street Address * 12204 BEGIN DRIVE
City, State Zip * RIVERVIEW, FL 33579
Email Address * BIGUN8PILL@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PETERSON   First Name   JADA
Policy # * ATH1115878 Claim #* AH141496
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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 ANY INDIVIDUAL FROM, OR AGENT OF, AMERICAN TRADITIONS INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM AND UNKNOWN TO THE INSURED.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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)(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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement; Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

American Traditions Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; and 9) failing to provide a loss run statement. On or about June 16, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by wind. The areas impacted include but are not limited to the roofing system. The Insured timely submitted a claim on June 19, 2024, to the Insurer for wind damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number AH141496 to the loss and sent a field adjuster to inspect the property on June 25, 2024. Then in a letter dated July 9, 2024, the Insurer notified the Insured that it was denying coverage for the loss. This coverage decision is incorrect. Denying coverage for the damage was wrongful as the damages are covered under the policy. Given the denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from wind, the Insured retained a roofing contractor. After assessing the damage and the true scope of repairs, the roofing contractor produced an estimate identifying $34,487.00 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the roofing contractor were sent to the Insurer. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's field adjuster observed damage to the insured property, but attributed the cause of this damage to several causes excluded by the policy. However, the Insurer never retained a professional engineer to determine the cause of this damage. Instead, the Insurer relied upon the causation opinions of a lay witness who will likely testify during his deposition that the Insurer never retained him to provide any causation opinions and lacks the credentials to even do so. Also, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. Lastly, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On July 24, 2024, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured's representatives. Lastly, the Insurer has failed or refused to promptly acknowledge the Insured's communications in an attempt to frustrate and delay the resolution of the Insured's claim. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Failing to provide a loss run statement 12. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-Mail: American Traditions Insurance Company 7785 66th Street Pinellas Park, FL 33781 aticclaims@westpointuw.com
Comments
User Id Date Added Comment
hfleming@tlsslaw.com 02-02-2025 This will respond to the Civil Remedy Notice of Insurer Violations (“Notice”) filed against American Traditions Insurance Company (“ATIC”). The Notice alleges Claim Denial,” “Claim Delay,” “Unfair Trade Practice,” “Misrepresenting the terms of the insurance policy,” “Not Treating the Insured with Good Faith Claims Conduct,” “Looking for Ways to Deny Full Recovery to The Insured,” “Looking for Ways to Delay Full Recovery to the Insured,” “Failing to properly investigate the Insured’s loss,” Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t [sic]”“Not Training, Supervising, or Managing Adjusters Properly so that Prompt and Full Payments are Made,” “Not adjusting claims and evaluating loss properly, “Shifting the burden of insuring the loss to the insured,” “Failing to implement proper standards for the adjustment and investigation of claims,” and “Intentionally misstating the terms, conditions, and benefits of the insurance policy to the Insured” as well as violations of Florida Statute § 624.155(1)(b)(1); as well as § 626.9541(1)(i)(2), (3)(a),(b) and (d). The allegations contained in the Notice are wholly without merit, and lack sufficient legal and factual support. Accordingly, ATIC denies each and every alleged violation of Florida statutory and administrative law as alleged in the Notice. As an initial matter, the Notice is deficient and fails to comply with the requirements of the Florida Statutes. Florida Statute § 624.155(3)(b) requires that a Civil Remedy Notice “state with specificity” the statutory provisions 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. Rather than include the specifics required by Statute regarding the facts and circumstances giving rise to the statutory provisions allegedly violated, the Notice makes general, boilerplate conclusions. Additionally, the Notice does not provide an explanation as to how ATIC failed to comply with the terms of the policy with specific factual support pertaining to the alleged incident or how ATIC failed to comply with the statutory provisions allegedly violated. Making general conclusions, without providing further analysis, or discussion of how ATIC violated the policy and/or statutory provisions, is in direct contradiction to Florida Statute § 624.155(3)(b) and renders the Notice defective. See Julien v. United Property & Casualty Insurance Company, 2020 WL 5652364 (Fla. 4th DCA 2020). As stated by the Florida Supreme Court, the purpose of a Notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to “cure” the alleged claim defects. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). The purpose of Fla. Stat. § 624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. See Talat Enterprises, Inc.; see also Lane v. Westfield Ins. Co., 862 So.2d 744 (Fla. 5th DCA 2003). Further, a Notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include i) identifying the specific policy provision(s) at issue, ii) citing specific language of the statutory provision(s) the insurer allegedly violated, and iii) specifically identifying what actions the insurer must take to remedy the alleged violations. Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. Aug. 13, 2010); Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299-1300 (S.D. Fla. 2008). Your Notice does not comply with the requirements of Florida law. Additionally, the “facts and circumstances” section of the Notice does not comply with Florida law. Contrary to the requirements of Florida Statutes, the Notice makes false, boilerplate accusations. For example, the Notice alleges that ATIC violated Florida Statute § 626.9541(1)(i)(3)(a)—failing to adopt and implement standards for the proper investigation of claims. However, the body of the Notice fails to describe how ATIC failed to adopt and implement standards to investigate the Insured’s claims. Similarly, the Notice does not provide factual support for various allegations listed above, including but not limited to how ATIC’s investigation was conducted in bad faith, or how ATIC has engaged in unfair trade practices or shifting the burden to the Insureds. Contrary to the allegations in the Notice, ATIC acted promptly, responsibly, and in good faith at every opportunity in connection with this claim. The failure to provide any factual support for the alleged violations of Florida statutory and administrative law and otherwise comply with the requirements of Florida Statute § 624.155, renders the Notice deficient and in violation of Florida Statute § 624.155. The true facts regarding the investigation and handling of this claim are as follows: The claim was reported on June 21, 2024. The date of the loss was reported June 16, 2024. The claim was reported after the Insured signed a contract with Gale Force Roofing. ATIC retained Menard Adjusting Company to assign an adjuster that could inspect the property, document the damage and provide photographs of the damage to ATIC. Following the inspection and review of the data collected, ATIC issued a coverage determination letter and advised that there was no evidence of a storm created opening and that the only damage observed was the result of wear and tear and the aging of the shingles. The Insured’s Notice also alleges a failure to communicate and a failure to provide a “loss run.” The Notice fails to acknowledge the email sent to Krapf Legal on August 8, 2024 and the attachments to that email. Additionally, a failure to provide a “loss run” is not bad faith under Florida Law. ATIC has responded to Insured’s counsel requests and had not delayed the handling of the claim. In fact, the loss was adjusted and a coverage determination made before the Insured’s counsel ever got involved. Without waiving its rights to contest the validity of the subject defective and improper Civil Remedy Notice, as the facts clearly demonstrate, ATIC has, and continues to comply with both Florida law and the applicable Policy throughout the entire handling of this claim. With regard to the investigation and handling of this claim, ATIC’s actions were prompt, thorough, and conducted in good faith. Therefore, ATIC specifically denies each and every violation alleged in the Notice.
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