Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 796812

Filing Accepted: 12/13/2024

Print Filing

Complainant

Last/Business Name *

ESTADA

First Name

JOANN

Street Address *

132 TRACY CIRCLE

City, State Zip *

HAINES CITY, FL 33844

Email Address *

JOANNESTADA@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		ESTADA		First Name		JOANN
Policy # *		FLA349664		Claim #*		1349772-241001

Attorney

Attorney is Applicable

Last Name*	ELAZAR First Name * SAPIR Initial
Street Address*		800 E BROWARD BLVD., STE. 510
City, State Zip*		FORT LAUDERDALE , FLORIDA 33301
Email Address *		SE@WEKLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		AMERICAN STRATEGIC INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10872

Name of individual responsible for violation (if any):* N/A
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	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)(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.

Joann Estada (the "Insured") purchased an insurance policy ("Policy") from American Strategic Insurance Corporation ("American Strategic"), with effective coverage on the date of the loss, on or about May 13, 2024, and policy number FLA349664 to insure her home located at 132 Tracy Circle, Haines City, FL 33844-4503 (the "Property"). On or about May 13, 2024, the Property suffered severe damage as the result of a windstorm, which caused ensuing damage to the Property, including but not limited to the roof and interior of the property. The Insured promptly reported her claim to American Strategic on May 14, 2024. American Strategic acknowledged receipt of the claim by generating claim number 1349772-241001. As required, American Strategic went to inspect the property and generated an estimate for the damages suffered. American Integrity made a low-ball coverage decision that broadly ignored the damage sustained to the Property valuing the damage at $156.98. It was clear that American Strategic was trying to reduce their contractual obligation by undervaluing the damage to the Insured’s Property from the start, even though the Insured actively provided all proof of claim needed to have her claim evaluated fairly. Despondent, the Insured retained Diamondback Public Adjusters, LLC (“Diamondback”) to act as her representative, to assist in the evaluation and inspection of damage to the property. Diamondback investigated the property and generated an estimate for the damage. Diamondback timely sent their estimate to American Strategic, which estimated the scope or damage to be $44,514.09, significantly more than the evaluation made by American Strategic. American Strategic’s dramatically insufficient coverage decision has resulted in further damages to the Insured by preventing her from returning her property to its pre-loss condition, rather than participating in the settlement process in good faith. As a direct consequence of American Strategic’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insured is continuing to sustain considerable hardship. Upon information and belief, American Strategic, as part of its general business practice, initially low-balls its policyholders. American Strategic 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 Strategic issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that American Strategic trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that American Strategic 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 American Strategic one initial low-ball payment – American Strategic stalls and intentionally delays the claim, changing adjusters, all under the false pretense that it’s “investigating” the claim. American Strategic 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 Strategic 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 the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insured has been treated in this manner by her insurance company after sustaining an obviously covered loss, submitting to every demand of American Strategic, and American Strategic failing to attempt to make a good faith effort to amicably come to a fair resolution. American Strategic violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by American Strategic 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 Strategic was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insured. While American Strategic 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 her home to its pre-loss condition in a timely fashion, American Strategic 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 Strategic 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 a proper investigation in this case. American Strategic 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’s claim, American Strategic has yet to rectify their actions and do right by the Insured by paying the money she is contractually owed. American Strategic 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 Strategic to this date, despite American Strategic being presented with the flawed rationale behind their underpayment of the Insured’s claim. American Strategic 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 has more than complied with each and every request and there has still been no action by American Strategic. In the event American Strategic needs additional information, they have failed to promptly notify the Insured in a timely manner. This pattern of behavior is perpetuated by American Strategic 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 Strategic 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 was not afforded the professional duties entrusted on American Strategic by the public. To date, American Strategic has failed to adequately compensate the Insured for the damage that occurred on May 13, 2024. As a direct result of American Strategic’s delay, the Insured was forced to seek the help of legal counsel to assist her. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that American Strategic knowingly and intentionally are delaying the claims process to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of American Strategic’s reckless delay of the claim process. The Insured is a dutiful customer who made it a priority to pay her insurance premiums to ensure that in such an event as this devastating incident, her home would be covered. The Insured timely filed her claim and fulfilled all her post-loss obligations. All requested information and documentation have been turned over to American Strategic and their representatives promptly by the Insured. However, American Strategic 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 she may remedy any deficiencies in her claim, and failed to provide her with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of their bargain after she satisfied all her 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 Strategic so often as to constitute a general business practice, evidencing a motive to enhance American Strategic’s profits, and designed to cause a detrimental effect to its policy holders. American Strategic was aware that the Insured’s damages were covered and took advantage of its Insured in an attempt to force her 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 to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should American Strategic 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 Strategic 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 ($44,514.09); (2) Agree to reimburse the Insured’s 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 has made a demand herein and has previously provided American Strategic with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insured is still willing to consider and to potentially accept any reasonable counter-offer made by American Strategic. Therefore, if American Strategic is not in agreement with the Insured’s reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, the Insured hereby requests that American Strategic now make a reasonable counteroffer before the expiration of the cure period.

Comments

User Id		Date Added		Comment
darryl_j_roles@progressive.com		01-15-2025		While American Strategic 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 Mr. Elazar, on January 15, 2025.

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