Filing Number: 796582
|
| Filing Accepted: 12/12/2024 |
| Last/Business Name
*
|
|
|
AUGUSTIN
|
|
First Name |
|
FLAYNA AND CHARLY |
|
| Street Address
*
|
|
C/O CARRINGTON JONES, ESQ 3333 S. ORANGE AVE, SUITE 104 |
| City, State Zip
*
|
|
ORLANDO,
FL
32806
|
| Email Address
*
|
|
CARRINGTON@MYLAWYERCAN.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
AUGUSTIN |
|
First Name |
|
FLAYNA AND CHARLY |
| Policy # * |
|
ATH1109525 |
|
Claim #* |
|
AH143269 |
|
Attorney is Applicable
|
| Last Name* |
JONES
First Name *
CARRINGTON
Initial
E
|
| Street Address* |
|
3333 S. ORANGE AVE, SUITE 104 |
| City, State Zip* |
|
ORLANDO
,
FL
32806
|
| Email Address * |
|
CARRINGTON@MYLAWYERCAN.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
AMERICAN TRADITIONS INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 12359 |
|
|
| Name of individual responsible for violation (if any):*
MARIA LEWIS
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Unfair Trade Practice
|
|
|
Claim Delay
|
|
|
*
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)(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)(4) |
|
Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
|
|
| 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.
American Traditions Insurance Company policy ATH1109525 provides coverage to Flayna Augustin and Charly Augustin for accidental direct physical loss to the property described in Coverage A. As such, this is an “all perils” policy and all such losses described above are covered unless they are specifically excluded.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
On or about October 9, 2024, Flayna Augustin and Charly Augustin (“Insureds”) suffered significant Hurricane Milton damage to their home located at 1897 Hickory Bluff Rd Kindred, FL 34744. Prior to the loss, American Traditions Insurance Company policy ATH1109525 provides coverage to Flayna Augustin and Charly Augustin for accidental direct physical loss to the property described in Coverage A. As such, this is an “all perils” policy and all such losses described above are covered unless they are specifically excluded.
American Traditions Insurance Company issued a homeowner’s insurance policy (policy no. ATH1109525) for the Insureds’ home. The policy was in effect on the date of loss and affords coverage for Hurricane Milton damage.
After providing notice of the loss, the insureds cooperated with American Traditions Insurance Company policy ATH1109525 provides coverage to Flayna Augustin and Charly Augustin for accidental direct physical loss to the property described in Coverage A and under the policy. As such, this is an “all perils” policy and all such losses described above are covered unless they are specifically excluded. The Insured(s) cooperated with the investigation of the claim and allowed American Traditions Insurance Company to inspect the damages on 10/21/2024. Despite American Traditions Insurance Company acknowledging a significant amount of covered damage, American Traditions Insurance Company refused to tender full payment to bring the insureds to pre-loss condition. This is a pattern and practice of American Traditions Insurance Company, finding that an Insureds damages fell below their deductible and or significant under valuing damages. The insureds home have sustained significant damage which far exceeds their deductible. Specifically the insureds known damage total $36,875.69.
Fla. Stat. § 624.155. Fla. Stat. 624.155 provides a cause of action for bad faith in first-party claims. Fridman v. Safeco Ins. Co., 185 So. 3d 1214, 1220 (Fla. 2016). These first-party claims are treated the same as third-party claims. Id. at 1221. The question of whether an insurer acted in bad faith is determined by the “totality of the circumstances” standard. Berges v. Infinity Ins. Co., 896 So. 2d 665, 680 (Fla. 2004). This inquiry focuses on the actions of the insurer. Id. at 677. The insurer has a duty to use the degree of care and diligence as a person of ordinary care. Bos. Old Colony Ins. Co. v. Gutierrez, 386 So. 2d 783, 785 (Fla. 1980). The insurer must investigate the facts, give fair consideration to all settlement offers, and settle when a reasonable prudent person would. Id. Additionally, an insurer must not act solely in their own interest in settlement. State Farm Mut. Auto Ins. Co. v. LaForet, 658 So.2d 55, 58 (Fla. 1995). Furthermore, the insurer has the burden to show that there was no realistic possibility of settlement. Powell v. Prudential Prop. & Cas. Ins. Co., 584 So. 2d 12, 14 (Fla. 3d DCA 1991). 624.155(1)(b) claims: [624.155(1)(b)(1)]: Insurer, American Traditions Insurance Company, acted in bad faith under Fla. Stat. 624.155(1)(b)(1) in their dealings with the Insureds by failing to attempt to settle the Insureds’ claims when it could and should have done so had it acted fairly and honestly toward the insured. As such, the insurer must promptly and immediately settle the claim. 624.155(1)(a)(1) claims: Fla. Stat. § 624.155(1)(a)(1) grants a cause of action against an insurer for unfair insurance trade practices under Fla. Stat. 626.9541(1)(i). Contrary to the language of the statute, a remedy exists even “without proof that the insurer committed unfair or deceptive acts with such frequency as to constitute a general business practice.” Dadeland Depot, Inc. v. St. Paul Fire & Marine Ins. Co., 945 So. 2d 1216, 1232 (Fla. 2006). Here, American Traditions Insurance Company’s actions constituted bad faith under 626.9541(1)(i)(3)(a). [626.9541(1)(i)(3)(a)]: Pursuant to Fla. Stat. 626.9541(1)(i)(3)(a), an insurer must adopt and implement standards for the proper investigation of claims. Plaintiff may bring a civil action for damages caused by the failure to adopt such standards. Fla. Stat. § 624.155(1)(a)(1). Here, the facts of this loss investigation indicate that Insurer does not have adequate standards for the proper investigation of claims. Here, Insurer has failed to assign competent and unbiased claims personnel.
American Traditions Insurance Company has not acted honestly or fairly towards its Insureds. American Traditions Insurance Company policy ATH1109525 provides coverage to Flayna Augustin and Charly Augustin for accidental direct physical loss to the property described in under coverage A and the policy in its entirety. As such, this is an “all perils” policy and all such losses described above are covered unless they are specifically excluded. American Traditions Insurance Company and its adjusters misrepresented the scope and cause of damages to the residence and misapplied exclusions in the policy, namely wear and tear, and “long term” damage, in order to deny or underpay coverage for the majority of the Insureds claim in order to ensure its valuation of the claim would be significantly less than the cost of repair. As is the case here, it has become a general business practice of American Traditions Insurance Company to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. American Traditions Insurance Company regularly undervalues claims in order to avoid issuing payment on losses that it knows are covered under the policy.
American Traditions Insurance Company also routinely refuses to pay claims in full when it has the ability to do so, waits to see if its insureds contest their coverage determination, as was necessary here, and, only then, will it capriciously invoke appraisal. American Traditions Insurance Company knows that by opening up a small amount of coverage, it can maintain its ability to demand appraisal later on and deprive its Insured access to the courts. Its insureds are then forced to pay the cost of their own appraiser and potentially an umpire, which can total several thousands of dollars, before it is ever willing to perform repairs or issue benefits that were already owed under the policy. American Traditions Insurance Company has developed this deliberate strategy in order to deter its Insureds from challenging its coverage determinations and hinder their ability to seek additional payment for monies owed under the policy. American Traditions Insurance Company’s practice of not adjusting losses in good faith in accordance with section 627.70131, Florida Statues, unnecessarily delays resolution of its claims and leaves claimants like the Insureds with no choice but to incur further time and expense just to be fully indemnified pursuant to the terms of their contract with American Traditions Insurance Company.
American Traditions Insurance Company has completely abdicated its duty to adjust and has put the onus on its Insureds to spend thousands of dollars in appraisal before American Traditions Insurance Company is willing to issue benefits or make repairs that it knows are owed pursuant to the policy. American Traditions Insurance Company’s pattern and practice of underrepresenting the actual cost and cause of damages, then demanding appraisal if challenged, is evidence that it does not act fairly or honestly towards the Insured during its adjustment process and that it has failed to implement proper standards for the investigation and handling of its claims.
American Traditions Insurance Company did not apply appropriate standards in order to properly investigate claims such as the Loss at the Home, which ultimately led to its unfair and dishonest adjustment of the Loss. American Traditions Insurance Company has implemented a strategy and approach to the Loss that is unfair and has not attempted to settle the Loss that that the Insured has suffered and continues to suffer.
American Traditions Insurance Company can cure its bad faith conduct by: 1) accepting the insured’s claim as compensable, and agreeing to pay the claim in accordance with its loss settlement provision prior to the expiration of the cure period, 2) reaching an amicable settlement of the pending claim prior to the expiration of the cure period, or 3) paying the amount of the estimate for damages ($36,875.69) submitted by the insured to American Traditions Insurance Company less the insured’s deductible. By doing any of these three things, the insurer will cure its bad faith in this case and extinguish any and all of its liability for all bad faith damages which could be sought pursuant to this Civil Remedy Notice.
|
|
|
*
|
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
|