Filing Number: 797022
|
| Filing Accepted: 12/16/2024 |
| Last/Business Name
*
|
|
|
VASSER; SILVER
|
|
First Name |
|
PATRICIA; EDDIE |
|
| Street Address
*
|
|
3608 JUNEBERRY DR |
| City, State Zip
*
|
|
WESLEY CHAPEL,
FL
33543-69
|
| Email Address
*
|
|
FOXYSILVER54@GMAIL.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
VASSER; SILVER |
|
First Name |
|
PATRICIA; EDDIE |
| Policy # * |
|
AGH0353868 |
|
Claim #* |
|
CHO-00172032 |
|
Attorney is Applicable
|
| Last Name* |
BRAZ
First Name *
TAMARA
Initial
|
| Street Address* |
|
8865 COMMODITY CIR. STE. 12 |
| City, State Zip* |
|
ORLANDO
,
FL
32819
|
| Email Address * |
|
TBRAZ@THELAWGICALFIRM.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 12841 |
|
|
| Name of individual responsible for violation (if any):*
? TIMOTHY HUNTER IV, FIELD CLAIMS ADJUSTER ON BEHALF OF AMERICAN INTEGRITY INSURANCE COMPANY;
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Unfair Trade Practice
|
|
|
Other
:
Failure to Properly Investigate
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
|
| 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)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
POLICY FORM: AIIC HO3 10 21
***
SECTION I – PROPERTY COVERAGES
COVERAGE A – Dwelling
1. We cover:
a. The dwelling on the “residence premises,” shown in the Declarations,
including attached structures and attached wall-towall carpeting if damage
to the dwelling is caused by a covered loss[.]
***
SECTION I – PERILS INSURED AGAINST
COVERAGE A – Dwelling and COVERAGE B – Other Structures
1. We insure for sudden and accidental direct loss to property described in
COVERAGE A - Dwelling and COVERAGE B- Other Structures only if that
loss is a physical loss to covered property[.]
***
SECTION I – CONDITIONS
***
2. Duties After Loss. In case of loss to a covered property, we have no duty to
provide coverage under the Policy if the failure to comply with the following
duties is prejudicial to us. These duties must be performed by either by you, an
“insured” seeking coverage or a representative of either…[.]
***
b. (1) To the degree reasonably possible, retain the damaged property and
(2) Allow us to inspect…[.]
***
(5) Cooperate with us in the investigation of a claim.
***
|
| |
*
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 January 9, 2024, Patricia Vasser and Eddie Silver (Complainant(s)) suffered a loss to their Property, located at the address listed above due to wind and hail. After discovering the damage, Complainant(s) reported the loss to American Integrity Insurance Company of Florida (“Insurer”) on or about March 15, 2024.
Throughout Insurer’s investigation, Complainant(s) 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 by failing to conduct a proper and fair investigation of the claim.
Following the report of the claim, on or about March 15, 2024, Complainants retained RRCA, Roofing and Construction of America to mitigate the damages and protect the subject property.
Subsequently, on or about March 18, 2024, Insurer issued a Reservation of Rights letter.
On or about March 23, 2024, RRCA Roofing conducted an inspection of the subject property. An estimate was created shortly after, on or about March 24, 2024.
RRCA Roofing identified damages amounting to $37,055.47 as Actual Cash Value and $45,251.39 as Replacement Cost Value.
On or about March 27, 2024, Timothy Hunter IV, the designated field adjuster (hereinafter “Field Adjuster”) for the claim, conducted an inspection of the property and took photographs.
Within the same day, the Field Adjuster produced an estimate and issued a coverage denial letter, stating that the estimated damages fell below the deductible.
The Field Adjuster’s estimate concluded a mere $740.38 in damages for only four shingles, entirely failing to address or include the substantial additional damage documented by RRCA Roofing.
On or about April 15, 2024, RRCA Roofing, through its representative, Bradley Dreher, provided evidence, including a brittle test, photographs, and video documentation, demonstrating that the roof's age and brittle condition rendered spot repairs impractical and unsuitable.
The brittle test showed that attempting to repair damaged shingles would compromise adjacent shingles, creating a chain reaction of further damage.
This was further substantiated in a follow-up email on or about April 21, 2024, which detailed specific areas of damage, including seven locations with lifted shingles that had pulled through nails and exhibited a zippering effect. RRCA Roofing further asked Insurer to conduct an additional inspection to alleviate the initial investigation.
On or about April 24, 2024, Insurer responded, asserting that it does not base coverage decisions on brittle tests and alleging that the brittle test conducted by RRCA Roofing was improperly performed.
Insurer further accused RRCA Roofing of causing non-peril-related damage to the roofing system and stated once more from an unqualified Field Adjuster that zippering and nail-pulled shingles resulted from improper installation or workmanship, not wind damage.
Despite substantial evidence and a specific request for a second inspection, Insurer outright refused to consider the new findings or re-evaluate the claim.
The Field Adjuster’s initial inspection failed to comprehensively identify or address significant wind-related damages, including the zippering effect and nail-pulled shingles documented by RRCA Roofing, which are consistent with wind damage exacerbated by the brittle condition of the roof.
By refusing to conduct a second inspection, Insurer disregarded the supplemental observations and Complainants’ right to a thorough investigation, leaving critical issues unresolved.
Insurer’s continuous reliance on speculative, unqualified assertions rather than engaging in a comprehensive, expert-supported investigation demonstrates a failure to follow the proper investigative procedures required by Fla. Stat. 626.9541(1)(i)(3)(a).
A Field Adjuster is only qualified to document the observed damages and report findings, not to determine causation or the extent of coverage under the policy. Causation determinations, especially involving issues such as wind damage, wear and tear, or age-related deterioration, require the expertise of qualified professionals.
By failing to involve a qualified expert to assess the damages and causation comprehensively, Insurer not only undermined the reliability of its findings but also intentionally sought to limit Complainants’ liability and deny rightfully owed benefits.
Insurer’s denial, based solely on the unqualified assessment of the Field Adjuster, ignored the policyholder’s reasonable expectation of a fair and expert-supported investigation and resulted in a misleading narrative about the true cause and extent of the damages, in violation of Fla. Stat. 626.9541(1)(i)(3)(b).
The claim was open for a mere 12 days. Further, Insurer reached its coverage decision within the same day of the Field Adjuster’s inspection. A reasonable investigation requires more than a cursory review of the evidence; it demands an active effort to gather relevant facts, engage qualified experts, and thoroughly assess all available information to make an informed and fair determination.
On or about June 14, 2024, Complainants retained The Lawgical for legal representation and a Letter Of Representation was promptly sent later that day.
Subsequently, on or about July 2, 2024, a third inspection was conducted by Alex Gonzalez on behalf of Property Claims Consultant, during which photographs were taken.
On or about July 28, 2024, Mr. Gonzalez produced an estimate amounting to $53,060.00 for Actual Cash Value and $54,383.86 for Replacement Cost Value.
To date, Insurer continues to stand by its initial denial, despite the presentation of two independent estimates, produced by RRCA Roofing and Alex Gonzalez, which substantially contradicted Insurer’s findings. Both estimates far exceed Insurer’s initial assessment of $740.38 by 40 to 50 times, revealing a significant undervaluation of the damages.
Despite being presented with this supplemental information and a specific request for a second inspection to reconcile significant discrepancies, Insurer neglected to re-evaluate the claim or facilitate a fair resolution.
This failure to fully commit to a meaningful investigation puts Insurer in violation of Fla. Stat. 626.9541(1)(i)(3)(d), which requires insurers to conduct reasonable investigations based on all available information to ensure claims are properly and thoroughly evaluated.
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 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 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 $53,596.00, 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.
|
|
|
*
|
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
|