Civil Remedy Notice of Insurer Violations
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Filing Number:     795664
Filing Accepted:  12/6/2024
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Complainant
Last/Business Name *  
POWELL   First Name   KEVIN
Street Address * 12086 ALEXANDRA DRIVE
City, State Zip * JACKSONVILLE, FL 32218
Email Address * GATORS7995@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   POWELL   First Name   KEVIN
Policy # * AGH0434618 Claim #* CHO-00173901
Attorney
Attorney is Applicable
Last Name* ELAZAR First Name * SAPIR Initial
Street Address* 800 EAST BROWARD BLVD. SUITE 510
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * SE@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
NAIC Company Code 12841
 
Name of individual responsible for violation (if any):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Delay
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)(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)(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.

Loss Payment Provision. Loss Settlement Provision.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Kevin Powell (the "Insured") purchased an insurance policy ("Policy") from American Integrity Insurance Company ("American Integrity"), with effective coverage on the date of the loss, on or about April 11, 2024, and policy number AGH0434618 to insure her home located at 12086 Alexandra Drive, Jacksonville, FL 32218 (the "Property"). On or about April 11, 2024, the aforementioned Property suffered severe damage as the result of Windstorm, which caused ensuing damages to the Property including but not limited to the exterior of the property. The Insured promptly reported their claim to American Integrity. American Integrity acknowledged receipt of the claim by generating claim number CHO-00173901. After considerable stalling, American Integrity went to inspect the property, as they are required to, and generated an estimate for the damages suffered. American Integrity initially made a low-ball coverage decision that broadly ignored the damage sustained to the Property valuing the damage at $915.01 which is less than $1000 deductible. It was clear that American Integrity was trying to reduce their contractual obligation by undervaluing the damage to the Insured’s Property from the start, despite the fact that the Insured actively provided all proof of claim needed to have their claim evaluated fairly. Despondent, the Insured retained Eco Restore, LLC. (“Eco Restore”) to act as their public adjuster, to assist in the evaluation and inspection of damage to the property. Eco Restore investigated the property and generated an estimate for the damages. Eco Restore immediately sent their estimate to American Integrity, which estimated the scope or damage to be $30,549.65 along with a request for supplemental payment, but American Integrity failed to issue any additional payment to the Insured. American Integrity’s dramatically insufficient coverage decision has resulted in further damages to the Insured by preventing them from returning their Property to its pre-loss condition, rather than participating in the settlement process in good faith. As a direct consequence of American Integrity’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insured and their family are continuing to sustain considerable hardship. Upon information and belief, American Integrity, as part of its general business practice, initially low-balls its policyholders. American Integrity does this in a calculated and systematic scheme that begins with manipulating the software system used in estimating its property damage claims. It appears that American Integrity issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that American Integrity trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that American Integrity knows most policyholders generally would not know to request but are actually covered under the insured’s policy. Moreover, as part of this scheme, after making one initial low-ball payment – American Integrity stalls and intentionally delays the claim, changing adjusters, all under the false pretense that it’s “investigating” the claim. American Integrity has violated Florida Statute § 624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. American Integrity has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this obviously covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insured have been treated in this manner by their insurance company after sustaining an obviously covered loss, submitting to every demand of American Integrity, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. American Integrity violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by making material misrepresentations to the Insured for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. American Integrity was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insured. While American Integrity was made aware of this information for the purpose of obtaining the money contractually owed to the Insured under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, American Integrity accepted that information and has used it to play the delay game with the Insured, knowing all too well the additional damage and hardship that was being placed on the Insured by its actions. American Integrity violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of proper investigation in this case. American Integrity and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insured. In addition, after being placed on notice as to the blatant underpayment of the Insured’ claim, American Integrity has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed. American Integrity violated § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon the communications with respect to the claim. There has yet to be significant action taken by American Integrity to this date, despite American Integrity being presented with the flawed rationale behind their underpayment of the Insured’ claim. American Integrity violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insured of any additional information necessary for processing the claim. The Insured have more than complied with each and every request and there has still been no action by American Integrity. This pattern of behavior is perpetuated by American Integrity and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insured throughout the insurance claim process. Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from American Integrity approaching the investigation and settlement in a manner prejudicial to the Insured, failing to allow a fair settlement with the Insured, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insured were not afforded the professional duties entrusted on American Integrity by the public. To date, American Integrity has failed to adequately compensate the Insured for the damage that occurred on April 11, 2024. As a direct result of American Integrity’s delay, the Insured were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that American Integrity knowingly and intentionally are delaying the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured and their family is a direct result of American Integrity’s reckless delay of the claim process. The Insured are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insured timely filed their claim and fulfilled all of their post-loss obligations. All requested information and documentation has been turned over to American Integrity and their representatives promptly by the Insured. However, American Integrity failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insured how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of their bargain after they satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Upon information and belief, the aforementioned actions complained of, among others, were made by American Integrity so often as to constitute a general business practice, evidencing a motive to enhance American Integrity’s profits, and designed to cause a detrimental effect to its policy holders. American Integrity was aware that the Insured’ damages were covered and took advantage of its Insured in an attempt to force them into an irreparably disadvantaged position, which they hope will force the Insured to settle for less coverage than they are contractually entitled to under the policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should American Integrity 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, American Integrity must: (1) Immediately tender all insurance proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insured’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insured 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; (4) Although the Insured have made a demand herein and have previously provided American Integrity with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insured are still willing to consider and to potentially accept any reasonable counter-offer made by American Integrity. Therefore, if American Integrity is not in agreement with the Insured’ reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, the Insured hereby request that American Integrity now make a reasonable counteroffer before the expiration of the cure period.
Comments
User Id Date Added Comment
swozniak@aii.com 01-07-2025 January 7, 2025 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, FL 32399-0322 Sapir Elazar, Esq. 800 East Broward Blvd. Suite 510 Fort Lauderdale, Florida 33301 SE@WekLaw.com Re: DFS File No: 795664 Complainant: Kevin Powell Insured: Kevin Powell Policy No: AGH0434618 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00173901 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Sapir Elazar, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on December 6, 2024 and assigned it DFS File No. of 795664. While American Integrity asserts that the subject CRN is legally insufficient and non-compliant with Florida law, American Integrity, without waiving any arguments regarding same, contends that it has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its Insured, Kevin Powell. The CRN contains a list of purported violations which are alleged to have been committed by American Integrity. In fact, none of the listed violations/allegations have occurred and/or are irrelevant to the alleged violations and American Integrity categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules contained in the CRN. In addition, American Integrity denies any and all allegations of any kind and/or any inferences therefrom referenced and/or contained in the CRN. American Integrity believes this response adequately addresses the allegations and violations contained within the CRN. Sincerely, Michael S. Sperounes Michael S. Sperounes, Esq. Senior Vice President of Litigation American Integrity Insurance Group cc: Sapir Elazar, Esq. via email at: SE@WekLaw.com CRN Response If this document contains an excerpt from an American Integrity Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the Insureds on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234
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