Civil Remedy Notice of Insurer Violations
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Filing Number:     794982
Filing Accepted:  12/3/2024
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Complainant
Last/Business Name *  
JEANTY   First Name   THERESA
Street Address * 31536 SPOONFLOWER CIR
City, State Zip * WESLEY CHAPEL, FL 33545
Email Address * BSF@ATILUSANDASSOCIATES.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JEANTY   First Name   THERESA
Policy # * MUH1030581 Claim #* AH143530
Attorney
Attorney is Applicable
Last Name* FETHERHUFF First Name * BRENDA Initial
Street Address* 515 E LAS OLAS BLVD, STE 120
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * BSF@ATILUSANDASSOCIATES.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):* SARAH AARON, MANAGEMENT, AND ALL HANDLING ADJUSTERS AND VENDORS
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)(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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

All pertinent policy languages, specifically as it relates to property damage due to sudden and accidental discharge or water, emergency mitigation services, protecting the property from additional damages.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The insured, Jeanty, reported the loss immediately to the insured upon the discovery of the plumbing failure. The plumbing failure was deemed to be the result of a failed shower pan and plumbing system. The ensuing damages from such loss are covered under the insured policy with the insurer. During the investigation of the claim, the insurer sent a vendor to conduct an inspection of the property. The vendor and the insurer failed to advise that said inspection would include destructive testing which would cause additional damage to the insured's property. The vendor then conducted said destructive testing at the direction of the insurer and resulted in additional damages to the insured's property as well as causing mold to grow posing a health threat to the insured and her family. Upon request of the insurer and vendor to address this issue, the insurer refused to reimburse the insured for the destructive testing and continues to ignore any request for said necessary repairs for their direct actions. Within minutes of being advised of the damages caused by the vendor, Sarah Aaron "consulted with her manager" and decided to deny any liability without conducting any investigation. These actions appear to be done with such careless disregard that said insurer must commit on a regular basis. The insurer continues to violates Florida's claims handling statutes. 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 handle to stop further insureds from being treated unfairly and wrongfully. In addition, the insurance company must monitor the actions of outside adjusters and appraisers to adequately ensure all persons are properly equipped and trained to determine a loss of this nature and fairly and honestly assist the insureds. Such guidelines must include removing template- based letters. Providing explanations for document requests made to the insured. 2. Immediately tender payment for all claimed damages by the insurer's vendor, including interest owed pursuant to statute. 3. Must act fairly and honestly towards the insureds and with due regard for its interest in attempting to process and settle the insureds’ claim. 4. Must not retaliate against the insured for filing this Civil Remedy Notice.
Comments
User Id Date Added Comment
jessicajgross.91@gmail.com 01-30-2025 January 30, 2025 VIA DFS UPLOAD & E-MAIL Brenda Fetherhuff, Esq. Atilus & Associates bf@atilusandassociates.com Re: Civil Remedy Notice of Insurer Violations DFS File No.: 794982 Complainant: Theresa Jeanty Insurance Company: American Traditions Insurance Company Policy No.: MUH1030581 Claim No.: AH143530 Property: 31536 Spoonflower Cir., Wesley Chapel, Florida 33545 Dear Ms. Fetherhuff: This correspondence is being sent in connection with the Civil Remedy Notice of Insurer Violations (“CRN”) received by American Traditions Insurance Company (“ATIC”) that was filed on December 3, 2024 through the Department of Financial Services (the “Department”) on behalf of Complainant Theresa Jeanty (the “Complainant”). The CRN concerns a property damage claim assigned AH143530 (the “Claim”) that was reported by Complainant’s representative under the homeowner’s insurance policy issued by ATIC bearing the number MUH1030581 (the “Policy”), which insured the dwelling located at 31536 Spoonflower Cir., Wesley Chapel, Florida 33545 (the “Property”), subject to the terms, conditions, exclusions, and endorsements, as more fully set forth therein, for an effective period of January 24, 2024 through January 24, 2025. Complainant contends within the CRN that the ceiling and upper cabinets located on the first level of the Property were damaged as the result of a shower pan leak in the upstairs master bathroom. As an initial matter, the CRN lacks specificity required by Florida Statute Section 624.155(3)(a) such as that it provides nothing more than vague, ambiguous, and conclusory allegations regarding what Complainant believes to be ATIC’s motivations, positions, and business practices – none of which are true or supported by fact. Florida law is clear that a Complainant is required to state with specific the “facts and circumstances giving rise to the violation,” to allow the insurer to understand and cure any purported violation. Longpoint Condo. Assn. v. Allstate Ins. Co., 2005 WL 1315810 (N.D. Fla. 2005). The CRN fails to specify the policy language that is relevant to the violation and instead, provides every section title of the Policy, which contains a copious number of provisions set forth therein. The CRN also blatantly fails to comply with Florida Statute § 624.155(3)(b) which requires a CRN to state with particularity the facts and circumstances giving rise to the violation, names of any individual involved in the alleged violation, reference to specific policy language, etc. inter alia. See Fla. Stat. § 624.155(3)(b)(2023). Here, Complainant fails to provide her contact information or concisely provide the names of all individuals involved in the alleged violation. A written CRN which is vague and “shotgun” in nature or is written in general terms fails the specificity requirement of the statute. See Heritage Corp. of South Fla. v. National Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294, 1300 (S.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. 2010); Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The very purpose of the civil remedy notice, pursuant to Chapter 624, is to inform the insurer of alleged violations with specific information to encourage settlement of the subject claim. “The sixty-day window [as provided for in F.S. §624.155] is designed to be a cure period that will encourage payment of the underlying claim, and avoid unnecessary bad faith litigation.” Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000). Notice sent to the Department of Insurance concerning settlement violation(s) is intended to serve as a basis for the Department to assist in the settling of claims and to monitor the insurance industry. Id. However, whenever a complainant provides little in the way of adequate notice, the statutory intent of the CRN is frustrated. Moreover, the CRN is premature as the Claim was reopened by ATIC on December 4, 2024, based on statements by Complainant’s representative that there was alleged mold damage at the Property subsequent to receiving ATIC’s coverage determination letter dated December 2, 2024. At no point in time did the Complainant or Complainant’s representative submit an invoice or estimate to ATIC specifying what the total amount of alleged damages were. The first time ATIC became aware of an estimate was on January 6, 2025 when Complainant attached one prepared by Claim Preparation Experts totaling $34,431.68 within the Notice of Intent to Initiate Litigation (the “Notice”) filed with the Department. Further, ATIC requested a re-inspection of the Property for the subject Claim in response to Complainant’s Notice which is tentatively scheduled on a date occurring after the response deadline to this CRN. On January 20, 2025, ATIC sent Complainant a formal correspondence in response to the Notice which not only reiterated in detail the findings set forth in the coverage determination letter for the Claim and advised that it conducted a prompt investigation, review, and evaluation of the disputed claimed stated in the Notice pursuant to Florida Statute § 627.70152(4)(a). Notably, in accordance with under Florida Statute § 627.70152(4)(a)(3), ATIC expressed that it would be electing to conduct a reinspection of the Property within fourteen (14) business days from the date of its correspondence. Thus, Complainant irrationally seeks that ATIC cure the purported violations in the CRN before having a full opportunity to complete a re-inspection of the Property notwithstanding the statutory right to do so. Pursuant to Florida law, an insurer waives any defects in a CRN if it fails to raise these deficiencies in its response. This includes such deficiencies as a misnomer in the name of the correct insurer, or the untimeliness of the CRN. Neal v. Geico Ins. Co., 48 Fla. L. Weekly D423, D424 (Fla. 4th DCA Feb. 22, 2023). ATIC does not waive compliance with any contractual, statutory, or constitutional right by responding to this CRN. Rather, in an abundance of caution, ATIC provides this timely response in an effort to overcome any rebuttable presumption of bad faith. ATIC denies all of the allegations contained therein and specifically denies that it has violated the Florida Statutes cited in the CRN in its handling of the Claim. As further evidence that ATIC has not violated any policy or statutory provisions, it summarizes below the following facts with such specificity to circumvent the blatant mischaracterizations set forth by Complainant in the CRN. On October 22, 2024, Complainant’s representative reported that the ceiling and upper cabinets located in the kitchen of the Property sustained damage as a result of a shower pan leak located in the upstairs master bathroom. Immediately upon notice of the Claim, ATIC sent Complainant a formal Claim Acknowledgment Letter, Mediation of Rights Letter, Homeowner Claims Bill of Rights Letter, and promptly retained an independent field adjuster (“FA”) for purposes of scoping, diagramming, and photographing the allegedly damaged property and adjacent areas. The following day, the FA requested a date and time to conduct a site inspection at the Property. On October 25, 2024, the FA inspected the Property. As evidenced by the photographs taken at the time of the inspection, the FA did not observe any signs of direct physical loss from the purported shower pan leak in the master bathroom. The FA noted overspray near the corner shower frame/baseboard that appeared to be reoccurring and potentially unrelated. ATIC then retained Bobby Johnston with Sleuth, Inc. to perform leak detection testing at the Property. On November 2, 2024, ATIC’s desk adjuster attempted to have a telephone conference with Complainant’s representative to discuss its decision to deny the Claim based on the policy exclusions and leak detection results. In response, Complainant’s representative ignored these details and accused ATIC of causing additional damage at the Property when Sleuth performed the leak detection test. ATIC also provided Complainant and her representative a Coverage Determination Letter that day formally explaining in detail the reason for denying the Claim. Specifically, ATIC expounded on its investigation revealing that the Property: (1) did not evidence any active pressurized water leaks contributing to symptoms/damage; (2) did not evidence any active leakage from master bathroom shower riser, arm, and/or mixing valve; and (3) did not evidence of any active shower drain or shower floor and drain connection leaks in master bathroom. ATIC also advised that the observed damaged to the kitchen ceiling, particularly in the absence of any pressurized water leak, was attributed to missing tile grout in the upstairs master bathroom shower, which allowed water to escape when the shower was in use. ATIC further provided citations to the applicable policy language in support of its decision to deny the Claim and requested that Complainant provide any additional new information that may alter the determination as soon as possible so it could be evaluated for purposes of ATIC providing a timely update on the coverage status. As explained by ATIC in its Coverage Determination Letter, the Policy does not cover the foregoing damages reported by Complainant as they did not result from a sudden and accidental loss but, rather, the result of lack of maintenance to the bathroom tile grout. Notwithstanding ATIC’s good faith investigation of the Claim, Complainant lists a number of reasons for submitting the CRN, all of which are inaccurate and completely devoid of fact. Complainant’s allegations further evidence the boilerplate nature of the allegations raised against ATIC. Specifically, Complainant cites statutory provisions under Florida Statute Section 624.155 and Florida Statute 626.9541 which lack specificity. As such, ATIC rejects the same as vague and statutorily non-compliant and further responses by stating the following: 624.155(1)(b)(1): ATIC denies this allegation as it has attempted in good faith to reach a resolution of the subject Claim. Specifically, an independent field adjuster retained by ATIC promptly scoped, diagrammed, and photographed the Property during his inspection. ATIC then conducted a re-inspection where a leak detection test was performed. Accordingly, ATIC has always acted fairly and honestly towards Complainant and with due regard for her interests. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. 624.155(1)(b)(3): ATIC denies this allegation as it has attempted to promptly settle claims the most recent of which can be demonstrated by its written response to Complainant’s Notice of Intent to Initiate Litigation where it requested a re-inspection of the Property pursuant to Florida Statute § 627.70152. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. 626.9541(1)(i)(3)(a): ATIC denies this allegation as it has adopted and continues to implement standards of the proper investigation of all claims. Specifically, ATIC conducted a thorough good faith investigation of the Property, including, without limitation two (2) separate site inspections done by an independent field adjuster and leak detection specialist. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. 626.9541(1)(i)(3)(b): ATIC denies this allegation as it has never at any point misrepresented pertinent facts or insurance policy provisions relating to coverages at issue. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. 626.9541(1)(i)(3)(c): ATIC denies this allegation as it promptly acknowledged and communicated with Complainant and/or her representative(s) as set forth by the foregoing facts. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. 626.9541(1)(i)(3)(d): ATIC denies these allegations as it denied the Claim after completing an extensive investigation that included two separate site inspections of Complainant’s property. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. 626.9541(1)(i)(3)(g): ATIC denies this allegation as it has at all times promptly notified Complainant of any additional information necessary for the processing of the Claim. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. 626.9541(1)(i)(3)(h): ATIC denies this allegation and further responds that it provided clear directives in writing to Complainant regarding the documentation requested. Complainant has provided absolutely no facts and circumstances to support the allegations made in this CRN. ATIC denies all of the allegations asserted against it in the CRN and states they are false, unfounded, and completely devoid of fact. ATIC further states that at no point in time has it ever acted in bad faith. ATIC has, at all times, even those material to this Claim: (a) acted in good faith to investigate the Claim, acting fairly and honestly in its dealings with Complainant and her representative(s); (b) promptly investigated Complainant’s Claim; (c) acknowledged and acted promptly in response to all communications with Complainant; and (d) complied with its obligations in accordance with the terms of the subject insurance contract and Florida law. If you are in need of or seek any further information, please feel free to contact the undersigned. Sincerely, /s/ Jessica J. Gross Jessica J. Gross H. Jacey Kaps
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