Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 795075

Filing Accepted: 12/3/2024

Print Filing

Complainant

Last/Business Name *

POOLE

First Name

ROBEE

Street Address *

4009 BILLINGSGATE ROAD UNIT 3102

City, State Zip *

ORLANDO, FL 32839

Email Address *

ROBEEPOOLE570@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		POOLE		First Name		ROBEE
Policy # *		FLP408101		Claim #*		1006195-221013

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
Insurer Name*		ASI PREFERRED INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 13142

Name of individual responsible for violation (if any):* KEVIN VOCE, PATRICIA RUDNICK, BREANNA DIPEOLU, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, ASI PREFERRED INSURANCE CORPORATION, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Unfair Trade Practice
	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
	Other : Making material misrepresentations

* Statutory provision(s) which the insurer allegedly violated.

	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)(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.

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. 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. 627.70131 (1)(a) - upon the Insurer receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, "agent" means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to Insureds represented by counsel beyond those communications necessary to provide forms and instructions. 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.

ASI Preferred Insurance Corporation (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of 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) shifting the burden of investigating the loss onto the Insureds; 9) failing to acknowledge and act promptly upon communications with respect to claims; 10) failing to respond to or acknowledge correspondence within statutory time period; 11) failing to provide a loss run statement; and 12) making material misrepresentations. On or about January 18, 2022, while the subject policy was in full force and effect, the insured property suffered a loss caused by a water leak. The areas impacted include but are not limited to the foyer, stairs, guest bathroom. The Insured timely submitted a claim on January 18, 2022, to the Insurer for damages caused by water and the ensuing damage therefrom. Given the scope and emergency nature of the damage, the Insured retained Quantum Restoration and IAQ to perform initial mitigation and mold testing. The aforementioned reports, estimates, and invoices were sent to the Insurer who thereafter assigned claim number 1006195-221013 to the loss and sent a field adjuster to inspect the property. Subsequently, the Insurer notified the Insured that it was extending coverage for the loss. However, the Insurer wrongfully undervalued the amount required to restore the insured property to its pre-loss condition, which resulted in only mold and water policy limits being issued to the Insured. Given the scope and nature of the damage, the Insured was forced to vacate the property, resulting in additional living expenses. Moreover, given the Insurer's delay in fully indemnifying the Insured for their loss, the property has yet to be restored to its pre-loss condition. The Insured has supplied the Insurer with evidence including but not limited to estimates, photographs, invoices, receipts, and reports that verify the Insurer has undervalued the amount required to restore the property to its pre-loss condition and to fully indemnify the Insured for what they are owed under the subject policy of insurance. 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. Furthermore, 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 June 17, 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 representative and have moreover failed or refused to promptly acknowledge the Insured's communications in an attempt to frustrate and delay the resolution of the Insured's claim. In addition, on July 2, 2024, July 10, 2024, July 17, 2024, and July 24, 2024, the Insured, through their legal counsel, asked for the Insurer to confirm receipt of the Letter of Representation that was sent on June 17, 2024. It was not until July 26, 2024, thirty-nine (39) days later, that the Insurer finally responded and said that it had received the Letter of Representation. This shows that Insurer has failed to acknowledge the receipt of communications within seven (7) days in violation of Florida Statute 627.70131(1)(a). Upon an Insurer's receiving a communication with respect to a claim, the Insurer shall, within seven (7) calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the Insurer which reasonably prevents such acknowledgement. The Insurer subsequently issued another coverage determination letter, dated November 13, 2024, in which it notified the Insured that it was denying a portion of their loss. The Insurer misrepresented the loss and issued a wrongful partial denial. The Insurer denied coverage for repairs to the toilet flange. Although the Insurer and Insured are in dispute about how the damage occurred, 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 conduct outlined above is done within the Insurer's routine course of the business. 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 undervalued the amount required to fully indemnify the Insured for their loss. 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 delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. 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 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Shifting the burden of investigating onto the Insured 9. Conducting inadequate investigations 10. Failing to provide a loss run statement 11. 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: ASI Preferred Insurance Corporation 1 ASI Way St. Petersburg, FL 33731 claims@asicorp.org

Comments

User Id		Date Added		Comment
darryl_j_roles@progressive.com		12-09-2024		While ASI Preferred Insurance Corp believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the notice in writing to Grant Krapf, on December 9, 2024.

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. 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.

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