Filing Number: 796957
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| Filing Accepted: 12/16/2024 |
| Last/Business Name
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WANG; ZHENG
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First Name |
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DANA; HAORAN |
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| Street Address
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10049 LAKE DISTRICT LN |
| City, State Zip
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ORLANDO,
FL
32832
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| Email Address
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DANAWANG@VERIZON.NET |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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WANG; ZHENG |
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First Name |
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DANA; HAORAN |
| Policy # * |
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AGD266382 |
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Claim #* |
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CDP00170362 |
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Attorney is Applicable
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| Last Name* |
BRAZ
First Name *
TAMARA
Initial
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| Street Address* |
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8865 COMMODITY CIR. STE. 12 |
| City, State Zip* |
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ORLANDO
,
FL
32819
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| Email Address * |
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TBRAZ@THELAWGICALFIRM.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 12841 |
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| Name of individual responsible for violation (if any):*
THOMAS MALFETTONE, FIELD CLAIM ADJUSTER ON BEHALF OF AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Improper Investigation Technique
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
DP 00 03 07 88
***
COVERAGES
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COVERAGE A – Dwelling
We cover:
1. the dwelling on the Described Location shown in the Declarations, used principally for dwelling purposes, including structures attached to the dwelling;
2. materials and supplies located on or next to the Described Location used to construct, alter or repair the dwelling on other structures on the Described Location[.]
***
DP 00 03 07 88
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PERILS INSURED AGAINST
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COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property[.]
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DP 00 03 07 88
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CONDITIONS
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4. Your Duties After Loss.
b. (1) protect the property from further damage;
(2) make reasonable and necessary repairs to protect the property
(3) keep an accurate record of repair expenses[.]
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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 April 29, 2023, Dana Wang and Haoran Zheng (Complainants) suffered a loss to their Property, located at the address listed above. After discovering the damage, Complainants reported the loss to American Integrity Insurance Company of Florida (“Insurer”) on or about January 2, 2024.
Throughout Insurer’s investigation, Complainants have fully cooperated with Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant’s custody, possession and control.
Insurer, however, has failed to fulfill its duties under the Policy and Florida law.
On or about January 15, 2024, Insurer sent Complainants a Reservation of Rights Letter. On or about January 22, 2024, a cursory inspection of the Property was conducted by Thomas Malfettone (“Field Adjuster”). An estimate was created finding damage to the roof totaling $633.81, which is under Complainants’ deductible of $1,000.
On or about January 25, 2024, a mere three days later, Insurer issued their coverage determination, explaining that there was damage “related to wind” on the roof, however, the damages fall under deductible. As a result no coverage could be afforded to Complainants. Insurer also claimed the remaining damages were due to wear and tear in the form of “granule loss and blistering”.
Throughout the investigation, Insurer failed to request any information from Complainants. Upon information and belief, Insurer solely based their findings on the unqualified field inspection.
The Field Adjuster was not retained, tasked, or qualified to determine or assess the cause of the reported loss. Yet, he was tasked with causation of this loss. The Field Adjuster has no other qualifications aside from his Florida 6-20 License which only provides the licensee the ability to (1) Determine the amount of a claim, loss, or damage payable under an insurance contract, or (2) Settle the claim, loss, or damage.
Insurer “investigated” the entire claim in a mere 23 days. Upon information and belief, Insurer is partaking in improper investigation techniques and sought to deny rightful remedies.
Insurer issued its denial based solely on the Field Adjuster’s limited findings, forgoing a thorough expert analysis essential to accurately determining the source and cause of the reported damages. Insurer’s hasty determination and investigation process fails to follow the guidelines of Fla. Stat. 626.9541(1)(i)(3)(a) which requires a proper investigation on all claims.
On or about April 2, 2024, Complainants retained The Lawgical Firm for assistance in handling their claim. A Letter of Representation was sent to Insurer promptly the same day. Insurer responded by acknowledging the representation as well as standing on their previous coverage determination, denying Complainants payment for any costs for the damage.
A Loss Consultant was retained on behalf of Complainants. On or about April 2, 2024, a visual inspection of the subject property was conducted by Complainants and their agents. An estimate found damage totaling $54,431.00, emphasizing the actual total damage there is to the Property.
On or about April 21, 2024, Complainants and their agents sent Insurer their estimate and photo report as supplemental evidence. However on or about April 24, 2024, a mere three days later, Insurer responded, rejecting the supplemental evidence and continuing to stand on its previous coverage determination.
On or about May 1, 2024, Complainants and their agents sent Insurer their completed Sworn Proof of Loss (“SPOL”). Complainants and their agents consistently made a good faith effort to fully adhere to the terms of the policy.
Despite this, Insurer failed to respond appropriately and did not take into account this information, which is not in compliance with Fla. Stat. 626.9541(1)(i)(3)(e). This statute provides that an Insurer has 30 days to confirm or deny coverage after a SPOL has been submitted. Insurer’s noncompliance has left the claim unresolved since its reporting.
Upon information and belief, Insurer has implemented an unreasonable company-wide policy to rely solely and heavily upon homeowners, most of whom have no background or knowledge in any of the trades involved in diagnosing a loss, to report losses with almost expert accuracy. This policy is not in line with the Insurer’s duty a “fair and honest treatment of the claimant” as it seeks only to protect the Insurer’s interests.
Overall, it is clear that Insurer wholly failed to investigate causation, having only sent adjusters who are only qualified to document the condition of the Property, and assign repair values.
Based on the events described above, it is clear that Insurer conducted an improper investigation by an inexperienced adjuster, who sped up and did not consider additional information for the determination, in efforts to intentionally minimize its liability, contrary to the policy and Florida law’s requirements.
Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue, and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds. These tactics are believed to be the general business practices of this Insurer.
Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $53,781.00, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy.
PLEASE GOVERN YOURSELF ACCORDINGLY.
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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.
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DFS-10-363
Rev. 10/14/2008
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